Baseline hepatitis B surface antigen and cirrhosis predict extended interferon therapy in chronic hepatitis B: A retrospective study

Abstract

BACKGROUND

Chronic hepatitis B (CHB) is a major global health burden, with China being the most affected. Achieving a clinical cure, defined as hepatitis B surface antigen (HBsAg) clearance, is the ideal treatment endpoint. While a 48-week interferon course is standard, extended therapy may improve HBsAg clearance rates. However, there exists a notable gap in predictive modeling studies concerning extended treatment courses (≥ 48 weeks).

AIM

To develop a predictive model for identifying patients who require extended interferon therapy (≥ 48 weeks) for HBsAg clearance.

METHODS

This multicenter retrospective study included CHB patients, including those with compensated cirrhosis, who achieved HBsAg clearance (HBsAg < 0.05 IU/mL) following treatment with pegylated interferon alpha-2b, either alone or in combination with nucleoside analogs. After propensity score matching, we employed least absolute shrinkage and selection operator (LASSO) regression and multivariate regression to identify independent predictors.

RESULTS

A total of 688 eligible patients with CHB were enrolled in this study. After propensity score matching at a 1:1 ratio, 375 patients remained, including 196 in the training cohort. Among the training cohort, 36 (18.37%) were classified in the extended course (≥ 48 weeks) and 160 (81.63%) in the regular course (< 48 weeks). LASSO and multivariate regression analyses identified baseline HBsAg and cirrhosis as significant risk factors for extended interferon therapy. The model demonstrated strong discriminatory ability, with the area under the curve of 0.83 [95% confidence interval (CI): 0.76-0.91] for the training cohort and 0.81 (95%CI: 0.71-0.90) for the externally validated cohort. The model’s predictive efficacy was not influenced by subgroup characteristics.

CONCLUSION

This study successfully constructed and validated a prediction model based on baseline HBsAg and cirrhosis to identify potential populations that may benefit from extended interferon therapy (≥ 48 weeks).

Keywords: Chronic hepatitis B; Clinical cure; Extended course of interferon; Hepatitis B surface antigen; Prediction model

Core Tip: This study’s innovation lies in its exploration of the factors influencing extended interferon therapy (≥ 48 weeks) through multicenter cohort data, thereby avoiding the premature termination of potentially effective therapies and providing an evidence-based foundation for individualized treatment planning. For the first time, it incorporates baseline cirrhosis status and constructs a predictive model that integrates baseline hepatitis B surface antigen levels. The model demonstrated strong discriminatory ability in both the training cohort and the externally validated cohort.