Robert P. Perrillo, MD; Fredric G. Regenstein, MD; Marion G. Peters, MD; Katherine DeSchryver-Kecskemeti, MD; Carol J. Bodicky, RN; Carolyn R. Campbell, BS; Mary C. Kuhns, PhD
Study Objective: To determine the efficacy of a short course of prednisone followed by recombinant interferon treatment in patients with chronic type B hepatitis.
Design: Randomized, controlled trial with a 5-month treatment phase and a 9-month observation period after treatment.
Setting: Two referral-based university-affiliated medical centers.
Patients: Thirty-nine clinically stable patients with chronic type B hepatitis, all of whom were positive for hepatitis B antigen, hepatitis B virus-associated-DNA (HBV-DNA), and DNA polymerase for at least 6 months before entry. Patients included 20 heterosexuals and 19 male homosexuals.
Interventions: Eighteen patients were treated with a 6-week tapered regimen of prednisone, followed by 90 days treatment with recombinant interferon alpha-2b; 21 patients were untreated controls. Paired liver biopsy specimens of 27 patients (pretreatment and 9 months after treatment) were blindly evaluated.
Measurements and Main Results: Nine treated patients had a sustained loss of HBV-DNA. In addition, eight treated patients lost hepatitis B e antigen and four became negative for hepatitis B surface antigen (HBsAg). When compared with controls the differences were statistically significant for clearance of HBV-DNA and HBsAg (P = 0.035 and 0.037, respectively). Treated patients who had a sustained loss of HBV-DNA had higher initial alanine amino-transferase levels, lower initial DNA and DNA polymerase levels, and were more frequently heterosexual. Patients who responded to treatment with the disappearance of hepatitis B e antigen and HBV-DNA had normal liver function tests and markedly improved liver histology during follow-up.
Conclusions: The immunologic priming provided by a short course of prednisone used with alpha interferon may be an effective treatment for selected patients with chronic type B hepatitis.
Robert P. Perrillo, Fredric G. Regenstein, Marion G. Peters, Katherine DeSchryver-Kecskemeti, Carol J. Bodicky, Carolyn R. Campbell, et al. Prednisone Withdrawal Followed by Recombinant Alpha Interferon in the Treatment of Chronic Type B Hepatitis: A Randomized, Controlled Trial. Ann Intern Med. 1988;109:95–100. doi: 10.7326/0003-4819-109-2-95
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Published: Ann Intern Med. 1988;109(2):95-100.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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