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KMID : 0816119990020020169
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Korean Journal of Pediatric Gastroenterolology and Nutrition
1999 Volume.2 No. 2 p.169 ~ p.177
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Therapeutic Efficacy of Prednisolone Withdrawal Followed by Recombinant α Interferon in Children with Chronic Hepatitis B
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Ryu Na-Eun
Hwang Tai-Ju
Ma Jae-Sook
Kim Byung-Ju
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Abstract
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Purpose: To evaluate the efficacy of interferon alpha therapy with or without
prednisolone in children with chronic hepatitis B.
Methods : Twenty-eight children (22 boys, 6 girls, mean age 130 months) had
seropositive results for HBsAg, HBeAg and HBV DNA; 11 had chronic persistent
hepatitis and 17 had chronic active hepatitis. The patients were divided into two groups
depending upon their imflammatory activity on liver biopsy, pretreatment serum ALT
levels and HBV DNA levels. Fourteen children (group 1: chronic active hepatitis, ALT
≥ 100 IU/L and HBV DNA ≤ 100 pg/300 μL) received interferon alpha 2a 5
Mu/m2 of body surface three times weekly for 6 months. Fourteen
children (group 2: chronic persistent hepatitis or chromic active hepatitis with ALT <
100 IU/L or HBV DNA > 100 pg/300 μL) received prednisolone in decreasing daily
doses of 60 ㎎/m2, 40 ㎎/m2, and 20 ㎎/m2,
each for 2 weeks, followed after 2 weeks by interferon alpha 2a on the same schedule.
At the end of therapy, 3 end points were analyzed: HBeAg seroconversion, serum ALT
normalization rate and clearance of serum HBV DNA.
Results : At the end of treatment, HBe antigen-to antibody seroconversion was higher
but not more significant in group 1 than group 2 (71.4% vs. 50.0%). Only one patient in
group 2 who lost HBeAg, also cleared HBsAg. ALT normalization was similar in both
groups (64.3% in group 1 vs. 55.6% in group 2). Clearance of serum HBV DNA was
observed in 78.6% of patients in group 1 and 64.3% in group 2, but no significant
differences. Complete response was similarly achieved in both groups (57.1% in group 1
vs. 50.0% in group 2). Interferon alpha therapy with prednisolone priming was well
tolerated and all children finished therapy.
Conclusion : The combined therapy with prednisolone followed by interferon alpha
may be safe and effective in inducing a serological and biochemical remission of the
disease in approximately 50% of children with chronic hepatitis B and with a high level
of viral replication and less active disease. However, a controlled study should be
performed to confirm these results.
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KEYWORD
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Chronic hepatitis B, Interferon, Prednisolone, Children,
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