| The Therapeutic Effect of Interferon-alpha Treatment in Children with Chronic Hepatitis B |
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Il Sang Jeong, Ki Sup Chung |
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Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea |
| 소아의 만성 B형 간염에 대한 Interferon-alpha의 치료 효과 |
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정일상, 정기섭 |
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연세대학교 의과대학 소아과학교실 |
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| Abstract |
Purpose
: The prevalance rate of chronic hepatitis B viral infection in children is high in our
contry. We performed a prospective study to evaluate the effectiveness of and the factors
predictive of response to interferon-alpha therapy in children with chronic hepatitis B.
Methods
: Thirty-two children with chronic hepatitis B werew admitted to the Department of
Pediatrics, Yonsei University College of Medicine from Oct. 1992 to Apr. 1994, and liver biopsies
were performed. They recieved interferon-alpha(Intermax-alpha: 3 million IU intramuscularly three
times a week) for from 4 to 6 months and were followed for 19¡¾7.5 months after treatment. The
control group comprised forty children with chronic hepatitis B who had conservative or no
treatment. The therapeutic effectiveness of IFN-alpha was evaluated, and factors predictive of
response to treatment were analyzed.
Results
:
1) Thirty two children in the treatment group comprised 22 males and 10 females. The mean age
was 11.7¡¾3.5 years at entry. The pathologic types were chronic lobular hepatitis in 4, chronic
persistant hepatitis in 12 and chronic active hepatitis in 16 cases. The mean age of 40 children in
the control group was 8.2¡¾4.4 years. There were no differences in the clinical and laboratory data
between the two group.
2) The serum ALT and AST levels normalized in 29(91%) of 32 treated cases and 33 (88%) of 40
controls. The normalization of serum aminotransferases in control group, however, was thought to
be meaningful because most controls were in healthy chronic carrier state with normal
aminotransferases levels. The serum HBV-DNA was cleared in 25(78%) of 32 treated cases and
7(41%) of 40 controls, which showed statistically significant difference (p< 0.005) between two
groups. HBeAg was cleared in 24(75%) of the treated cases and 10(25%) of 40 controls(p< 0.05).
The positive seroconversion of anti-HBe was noted in 18(56%) of 32 treated cases and 7(18%) of
40 controls(p< 0.05).
3) Normalization rate of AST and ALT levels, the clearance rate of HBV-DNA and HBeAg, and the seropositive rate to anti-HBe were 100%, 50%, 75% and 50% in CLH; 83%, 75%,
58% and 42% in CPH; 94%, 88%, 88% and 69% in CAH, respectively.
4) Children with higher pretreatment peak ALT level were more likely to clear HBeAg and
HBV-DNA. The clearance of HBeAg and HBV-DNA were 6(55%) and 5(45%) of 11 children with
pretreatment peak ALT level of less than 100IU/L; 6(75%) and 7(88%) of 8 children with pretreatment
peak ALT level of 100-200IU/L; 12(92%) and 13(100%) of 13 children with pretreatment peak
ALT level of greater than 200IU/L.
5) Children with lower pretreatment HBV-DNA level were more likely to clear HBeAg and
HBV-DNA. The clearance of HBeAg and HBV-DNA were 13(72%) and 14 (78%) of 18 children
with pretreatment HBV-DNA level less than 100pg/ml; 2(40%) and 2(40%) of 5 children with
pretreatment HBV-DNA level greater than 100pg/ml.
6) Children with higher post-treatment peak ALT level were more likely to clear HBeAg and
HBV-DNA. The clearance of HBeAg and HBV-DNA were 8(73%) and 7(64%) of 11 children with
posttreatment peak ALT level less than 100IU/L; 9(69%) and 10(77%) of 13 children with
post-treatment peak ALT level of 100-200IU/L; 7(88%) and 8(100%) of 8 children with posttreatment
peak ALT level greater than 200IU/L.
7) Normalization of serum ALT and AST level took 7.1¡¾6.8 months. The clearance of HBV-DNA
and HBeAg took 12.9¡¾8.3 and 10.1¡¾7.3 months, respectively. positive seroconversion to antiHBe
was obserbed at 10.6¡¾6.3 months after IFN-alpha treatment.
Conclusion
: These results suggest that interferon-alpha therapy can induce an increased
clearance of HBV-DNA and HBeAg with an increased positive seroconversion to anti-HBe in
children with chronic type B hepatitis. Factors that may help in in identifying those children with
a better chance of responding, were higher pre- and post-treatment peak ALT levels and lower
pretreatment peak HBV-DNA levels. |
| Key Words:
Interferon-alpha therapy, Chronic hepatitis B in children |
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