Younger age predicts increased HBsAg loss in children with chronic hepatitis B on antiviral therapy: A systematic review and meta-analysis
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Abstract Background: Increasing evidence has suggested that the early initiation of antiviral treatment promotes better treatment responses in young children with chronic hepatitis B (CHB), including functional cure. But there are limited studies regarding the clinical responses of antiviral treatment for these children. This study aims to explore the relationship between age at the initiation of antiviral therapy and hepatitis B surface antigen (HBsAg) loss among pediatric patients. Methods: We systematically searched five electronic databases and reviewed relevant research, and then conducted two-arm and single-arm meta-analyses of treatment responses among children with CHB to explore the effect of baseline age on treatment responses. Finally, based on the different clinical phases of CHB, treatment regimens, and observation end points, subgroup analysis was also conducted to find possible influence factors during the treatment. The primary outcome was HBsAg loss. Results: Eighteen studies involving 2,459 children with CHB were analyzed in this systematic review and meta-analysis. Children aged 1–7 years with CHB exhibited better treatment responses than those aged 8–18 years (odds ratios: HBsAg loss, 5.584 [4.069–7.664] ; HBV DNA suppression, 1.946 [1.356–2.793]; hepatitis B e antigen [HBeAg] loss, 2.369 [1.612–3.482]; HBeAg seroconversion, 3.094 [2.196–4.360]; and HBsAg seroconversion, 4.970 [1.503–16.439]), especially among children with CHB in the immune-clearance phas
Abstract
Abstract Background: Increasing evidence has suggested that the early initiation of antiviral treatment promotes better treatment responses in young children with chronic hepatitis B (CHB), including functional cure. But there are limited studies regarding the clinical responses of antiviral treatment for these children. This study aims to explore the relationship between age at the initiation of antiviral therapy and hepatitis B surface antigen (HBsAg) loss among pediatric patients. Methods: We systematically searched five electronic databases and reviewed relevant research, and then conducted two-arm and single-arm meta-analyses of treatment responses among children with CHB to explore the effect of baseline age on treatment responses. Finally, based on the different clinical phases of CHB, treatment regimens, and observation end points, subgroup analysis was also conducted to find possible influence factors during the treatment. The primary outcome was HBsAg loss. Results: Eighteen studies involving 2,459 children with CHB were analyzed in this systematic review and meta-analysis. Children aged 1–7 years with CHB exhibited better treatment responses than those aged 8–18 years (odds ratios: HBsAg loss, 5.584 [4.069–7.664] ; HBV DNA suppression, 1.946 [1.356–2.793]; hepatitis B e antigen [HBeAg] loss, 2.369 [1.612–3.482]; HBeAg seroconversion, 3.094 [2.196–4.360]; and HBsAg seroconversion, 4.970 [1.503–16.439]), especially among children with CHB in the immune-clearance phase. The pooled rates of HBV DNA suppression, HBeAg loss, HBeAg seroconversion, HBsAg loss, and HBsAg seroconversion of children aged 1–7 versus 8–18 years were 85.7% versus 71.2% (> 0.05), 74.4% versus 52.0% (< 0.01), 70.6% versus 38.9% (< 0.01), 54.5% versus 18.8% (< 0.001), and 62.0% versus 17.5% (< 0.05), respectively. Conclusions: Baseline age at the initiation of antiviral treatment is associated with HBsAg loss in children with CHB. Since all the available data came from observational studies, our findings should be validated by further multicohort randomized controlled trials. Registration: This study was registered in PROSPERO (CRD42024483967).