Potential conflict of interest: Nothing to report.
Proceed with caution: Peginterferon alpha-2a versus peginterferon alfa-2b in chronic hepatitis C. A systematic review of randomized trials†
Article first published online: 23 NOV 2010
Copyright © 2010 American Association for the Study of Liver Diseases
Volume 52, Issue 6, pages 2240–2241, December 2010
How to Cite
Kershenobich, D., Muñoz, L., Malé, R., Gaytan, J. and Sánchez, F. (2010), Proceed with caution: Peginterferon alpha-2a versus peginterferon alfa-2b in chronic hepatitis C. A systematic review of randomized trials. Hepatology, 52: 2240–2241. doi: 10.1002/hep.24025
- Issue published online: 23 NOV 2010
- Article first published online: 23 NOV 2010
- Accepted manuscript online: 6 OCT 2010 12:00AM EST
To the Editor:
Recently, Awad et al.1 presented a meta-analysis comparing peginterferon alfa-2a and peginterferon alfa-2b for the treatment of hepatitis C virus (HCV) infection. The authors conclude: “Current evidence suggests that peginterferon alpha-2a is significantly superior to peginterferon alfa-2b regarding benefits (SVR, which is clearance of the virus from the blood)”. After a careful revision of the article by Awad et al. and the original articles included in the meta-analysis, the conclusion they reach must be interpreted with caution. A main principle of meta-analysis deals with the homogeneity of the trials that will be analyzed together, in both aspects: population under study and methodological issues.2, 3 In addition, the quality of individual trials is important. However, these principles are not completely satisfied in the work of Awad et al.:
- 5In the meta-analysis, 1016 patients with a lower dose of peginterferon alpha-2b were included.
Simultaneously, Alavian et al.12 presented a very similar article: “The Comparative Efficacy and Safety of Peginterferon Alpha-2a vs. 2b for the Treatment of Chronic HCV Infection: A Meta-Analysis.” Alavian et al. analyzed only five of the eight trials used by Awad et al. Alavian et al. reach nearly the same conclusion, but at the same time stated “A longer duration of maximum serum concentration compared with PEG-IFN-α2b (168 versus 48-72 hours) yields greater SVR and higher neutropenia in PEG-IFN-α2a recipients.” Both authors1, 12 mentioned some awareness about the quality of the meta-analysis and the studies included in it. We think that conclusion must be interpreted both in light of the included trials and considering the effects of other factors, such as baseline HCV level, sex, race, and genotype. We strongly believe more research is needed before it is concluded one peginterferon is better than the other.
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- 2Meta-Analysis in Medical Research: The Handbook for the Understanding and Practice of Meta-Analysis. Oxford, UK: Blackwell Publishing Ltd.; 2005.
- 3Meta Analysis: A Guide to Calibrating and Combining Statistical Evidence. Chichester, UK: John Wiley & Sons Ltd.; 2008., ,
- 4A randomized prospective clinical trial comparing pegylated interferon alpha 2a/ribavirin versus pegylated interferon alpha 2b/ribavirin in the treatment of chronic hepatitis C [Abstract]. Am J Gastroenterol 2004; 99: 237., , , ,
- 5Relevance between fibrosis and response to treatment with peginterferon alf2 vs alfa2b with ribavirin in chronic hepatitis C genotype 3 patients. Randomized open label study [Abstract]. HEPATOLOGY 2008; 48: 1278., , ,
- 6Peginterferon alfa-2a plus ribavirin is more effective than peginterferon alfa-2b plus ribavirin for treating chronic hepatitis C virus infection. Gastroenterology 2010; 138: 116-122., , , , , , et al.
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- 9Randomized trial comparing pegylated interferon alpha-2b versus pegylated interferon alpha-2a, both plus ribavirin, to treat chronic hepatitis C in human immunodeficiency virus patients. HEPATOLOGY 2009; 49: 22-31., , , , , , et al.
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David Kershenobich M.D., Ph.D.*, Linda Muñoz, René Malé, Jesús Gaytan§, Francisco Sánchez¶, * Laboratorio de Hígado, Páncreas y Motilidad, Departamento de Medicina Experimental, Facultad de Medicina de la UNAM, Hospital General de México, México DF, México, Unidad de Hígado, Departamento de Medicina Interna, Hospital Universitario “Dr. José E. González” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México, Centro de Enfermedades Digestivas y Hepáticas SC, Instituto de Salud Digestiva y Hepáticas SC, Guadalajara, Jalisco, México, § Hospital de Infectología. Centro Médico Nacional “La Raza”. Instituto Mexicano del Seguro Social, México DF, México, ¶ Departamento de Gastroenterología. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México DF, México.