Interferon-based optimal antiviral strategies in underage patients with chronic hepatitis B: A propensity score-weighted cohort study

Objectives

Effective treatment of chronic hepatitis B (CHB) in childhood is critical to achieve the goal of eliminating hepatitis B. This study aims to assess the real-world efficacy and safety of different interferon(IFN)-based antiviral strategies in CHB children.

Methods

CHB children with elevated ALT or aspartate aminotransferase (AST) and measurable HBV DNA were included. A propensity score weighted analysis was performed and rate of serum hepatitis B surface antigen (HBsAg) loss was the main outcome measure.

Results

Totally, 809 patients were enrolled and divided according to different antiviral regimens, including 163 with IFN monotherapy, 325 with IFN-nucleos(t)ide analogues(NA) sequential therapy and 321 with de novo IFN and NA combination therapy. Mean age were 5.9 ± 4.0 years. Median follow-up time was 78.4 months. Generalized overlap weighting analysis showed that de novo IFN and NA combination therapy and IFN monotherapy were better than IFNNA sequential therapy but that no significant difference (P = 0.5999) existed between IFN monotherapy and de novo IFN and NA combination therapy. In the sensitivity analysis, the outcomes from inverse probability of treatment weighting were consistent with those from generalized overlap weighting, but no significant difference (P = 0.0605) was revealed between IFN monotherapy and IFNNA sequential therapy in the multivariable analysis using crude data. Serious adverse events were not observed among the patients.

Conclusions

In this cohort study involving the hitherto largest sample of underage CHB patients, IFNNA sequential treatment, though it is commonly used, seems suboptimal in HBsAg clearance. Our results favour the combination of IFN and NA at inception.