Published online Jul 21, 2010. doi: 10.3748/wjg.v16.i27.3465
Revised: February 22, 2010
Accepted: March 1, 2010
Published online: July 21, 2010
AIM: To establish a predictive algorithm which may serve for selecting optimal candidates for interferon-α (IFN-α) treatment.
METHODS: A total of 474 IFN-α treated hepatitis B virus e antigen (HBeAg)-positive patients were enrolled in the present study. The patients’ baseline characteristics, such as age, gender, blood tests, activity grading (G) of intrahepatic inflammation, score (S) of liver fibrosis, hepatitis B virus (HBV) DNA and genotype were evaluated; therapy duration and response of each patient at the 24th wk after cessation of IFN-α treatment were also recorded. A predictive algorithm and scoring system for a sustained combined response (CR) to IFN-α therapy were established. About 10% of the patients were randomly drawn as the test set. Responses to IFN-α therapy were divided into CR, partial response (PR) and non-response (NR). The mixed set of PR and NR was recorded as PR+NR.
RESULTS: Stratified by therapy duration, the most significant baseline predictive factors were alanine aminotransferase (ALT), HBV DNA level, aspartate aminotransferase (AST), HBV genotype, S, G, age and gender. According to the established model, the accuracies for sustained CR and PR+NR, respectively, were 86.4% and 93.0% for the training set, 81.5% and 91.0% for the test set. For the scoring system, the sensitivity and specificity were 78.8% and 80.6%, respectively. There were positive correlations between ALT and AST, and G and S, respectively.
CONCLUSION: With these models, practitioners may be able to propose individualized decisions that have an integrated foundation on both evidence-based medicine and personal characteristics.