IL-23 predicts PegIFN response in chronic HBV

By Shreeya Nanda, Senior medwireNews Reporter

High baseline serum levels of interleukin (IL)-23 can help to identify hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients who are likely to respond to pegylated interferon (PegIFN) treatment, a Chinese study indicates.

Baseline serum levels of the cytokines IL-23 and IL-17, which the researchers explain are implicated in the development of chronic inflammation in chronic hepatitis B patients, were significantly higher in the 72 HBeAg-positive chronic HBV patients than in the 55 HBeAg-negative patients.

After a 48-week course of PegIFN-α treatment and a follow-up period of equal length, 42 HBeAg-positive patients achieved HBeAg clearance and 40 showed a reduction in hepatitis B surface antigen (HBsAg) levels of greater than 1 log₁₀IU/mL.

These patients had significantly higher baseline levels of serum IL-23 and IL-17 than those who remained HBeAg-positive or those with an HBsAg decline of less than 1 log₁₀IU/mL, respectively.

Receiver operating characteristic curve analysis showed that IL-23, at a cutoff of 135 pg/mL, had an accuracy of 70.6%, with 71.4% sensitivity and 70.0% specificity, for predicting HBeAg clearance following PegIFN treatment.

And multivariate analysis showed that a high (>135 pg/ mL) pre-treatment level of IL-23 was the only parameter that was significantly associated with therapeutic response, that is, HBeAg clearance and HBsAg decline.

But Lanjuan Li, from Zhejiang University in Hangzhou, and colleagues report that on-treatment changes in IL-23 level, assessed at 12 weeks, did not correlate with response, and neither did changes in IL-17 levels.

However, early on-treatment decline in serum HBsAg significantly predicted HBsAg reduction after completion of treatment.

The researchers propose using baseline serum levels of IL-23 together with on-treatment HBsAg changes to identify patients with a high and low likelihood of response.

“This distinction can help clinicians encourage patients with a high probability to continue with their current regimen and to modify the regimen earlier for patients with a low probability of response”, they write in Liver International.

Li et al note that adherence to PegIFN can be low owing to side effects, but if patients are made aware that they are likely to respond well to treatment, this can “increase patient compliance and thus achieve a higher therapeutic response”.

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