Serological and molecular response on combined antiviral treatment in children with chronic hepatitis B after pediatric malignancy.

Abstract

BACKGROUND:

Chronic hepatitis B is a serious long-term problem for children surviving malignancy. The annual rate of spontaneous clearance of hepatitis B e antigen (HBeAg) is only 3% in these patients, and the response to monotherapy with interferon (IFN)-alpha is also low.

OBJECTIVE:

To monitor the serological and molecular response on combined antiviral treatment in children with chronic hepatitis B after pediatric malignancy.

STUDY DESIGN:

Twelve patients with a history of childhood malignancy and chronic hepatitis B were treated with prednisone for 4 weeks (0.6 mg/kg body weight per day orally for 3 weeks followed by 0.3 mg/kg body weight per day for 1 week) followed by IFN-alpha-2a (5 megaunits/m(2) body surface area, three times a week, subcutaneously) at least for 1 year. After 1 year of IFN-alpha monotherapy, treatment was discontinued in patients with HBeAg seroconversion as well as patients without HBeAg seroconversion and a decrease of serum hepatitis B virus (HBV) DNA level less than 0.5 logs of the basal level. Patients who had a decrease of the serum HBV DNA of more than 0.5 logs of the basal level underwent treatment continuation with IFN-alpha combined with famciclovir (FAM) (20 mg/kg body weight per day orally) for another year.

RESULTS:

After 1 year of IFN-alpha monotherapy, a decrease of the serum HBV DNA level to less than 0.5 logs was found in eight of 12 patients. Two of them additionally developed HBeAg seroconversion after 3 and 12 months. The remaining six patients received antiviral treatment with IFN-alpha combined with FAM for another year. Two of them showed HBeAg seroconversion after 21 and 24 months from study entry. HBeAg seroconversion was only observed in patients who had a decrease of serum HBV DNA to levels below 1 x 10(6) copies/ml. Treatment-induced toxicity was moderate and reversible in all patients.

CONCLUSION:

Combination treatment of chronic hepatitis B with prednisone, IFN-alpha, and FAM seems to be a safe and effective treatment option for children surviving pediatric malignancy.

• Authors: Herwig Lackner, Andrea Moser, Martin Benesch, Johann Deutsch, Harald H Kessler, Reinhold Kerbl, Wolfgang Schwinger, Hans Jürgen Dornbusch, Petra Sovinz, Christian Urban
• Journal: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology (J Clin Virol) Vol. 25 Suppl 3 Pg. S73-9 (Dec 2002) ISSN: 1386-6532 [Print] Netherlands
• PMID: 12467780 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antiviral Agents
• DNA, Viral
• Interferon alpha-2
• Interferon-alpha
• Recombinant Proteins
• 2-Aminopurine
• Famciclovir
• Prednisone

Topics

• 2-Aminopurine (analogs & derivatives, therapeutic use)
• Adolescent
• Antiviral Agents (adverse effects, therapeutic use)
• Child
• Child, Preschool
• DNA, Viral (analysis)
• Drug Therapy, Combination
• Evaluation Studies as Topic
• Famciclovir
• Female
• Hematologic Neoplasms (complications)
• Hepatitis B, Chronic (drug therapy, immunology, virology)
• Humans
• Interferon alpha-2
• Interferon-alpha (administration & dosage, adverse effects, therapeutic use)
• Male
• Prednisone (administration & dosage, adverse effects, therapeutic use)
• Recombinant Proteins
• Safety
• Serotyping
• Treatment Outcome