A comparison between the effect of oral antiviral and pegylated-interferon alpha treatment in chronic heptitis b patients

v IV. ABSTRACT A COMPARISON BETWEEN THE EFFECT OF ORAL ANTIVIRAL AND PEGYLATED-INTERFERON ALPHA TREATMENT IN CHRONIC HEPTITIS B PATIENTS Dr. Esra ERDOĞAN Dissertation, Department Of Internal Medicine Thesis Supervisor: Yrd. Doç. Dr. Ayhan BALKAN August 2017, 79 Pages Introduction and aim: Chronic Hepatitis B (CHB) is an important public health problem that infect 350-400 million people world wide. Despite the efforts to treat this disease, successful results in HBsAg marker loss and cure have not been achieved. In this study, we aim to investigate the efficacy and resistance rates of Pegylated interferon alfa and oral antiviral treatment given in CHB patients according to the Declaration for Health Application (DHA). Materials and Methods: We retrospectively studied 270 patients with CHB infection who were admitted to our outpatient clinic between January 2012 and December 2014. Patients were given pegylated-interferon alpha (PegIF-α) and oral antiviral treatments. A 3-year virological, biochemical and serological responses of the patients were examined and the efficacy of the antiviral drugs used for CHB infection was compared. Results: Of the 270 patients we studied, 178 (65.9%) were male and 92 (34.1%) were female. The mean age was 42.6 ± 12.1. 99 patients received tenofovir, 65 patients received entecavir, 54 patients received lamivudine, 32 received telbivudine and 20 received PegIF-α. At the end of the first year, HBeAg-positive CHB patients had virologic response rates of 12.5% in the PegIF-α group, 27.3% in the lamivudine group, 50% in the telbivudine group, 54.5% in the entecavir group and 55% in the tenofovir group. At the end of the first year in the HBeAg negative CHB patients, the virologic response rates were 58.3% in the PegIF-αgroup, 69.8% in the lamivudine group, 78.6% in the telbivudine group, 87.5% in the entecavir group and 79.7% in the tenofovir group. At the end of the first year HBeAg seroconversion rate was , in the PEGIF-α group %15, in the lamivudine group %13, in the telbivudine group %9.4 ,in the entecavir group %32.3 ,and in the tenofovir group %13.3. At the end of the 3rd year oral antiviral drug resistance was evaluated with the following results, 63% in lamivudine group, 23.1% in entecavir group, 15.6% in telbivudine group and 12.1% in tenofovir group. At the end of the third year, HBsAg negativity was found to be 1.9% in the lamivudine group, 3.1% in the telbivudine group and 4% in the tenofovir group. Patients using Peg-IFN-α and entacavir did not experience HBsAg loss. Conclusion: When evaluated in terms of virological response and resistance development, tenofovir and entecavir treatment were the most effective treatment in CHB. The lowest virological response rate was in the PegIF-α. While lamivudine initially had a good virological response rates, the resistance rates increased over time. When all treatments are evaluated, loss of HBsAg and cure rates are insufficient. Key words: Chronic hepatitis B, pegylated interferon alpha, oral antiviral, virologic response, resistance