Abstract: Objective To evaluate the efficacy and safety of 4 treatment options for HBeAg-positive chronic hepatitis B (CHB)
patients following a suboptimal response to 24-week interferon monotherapy. Methods The data of 193 HBeAg-positive CHB
patients with suboptimal response to 24-week interferon monotherapy were collected from Nanfang Hospital between
September, 2010 and January, 2013. According to the subsequent treatments, the patients were divided into group A with
additional entecavir or adefovir, group B with further interferon monotherapy, group C with conversion to NAs therapy, and
group D with direct therapy withdrawal, and the biochemical and virological results at weeks 24, 48 and 72 were analyzed in
the 4 groups. Results At week 48, the HBV DNA negative rates and serum alanine aminotransferase (ALT) normalization rates
were both significantly higher in group A and C than in group B (P<0.05); in group A, ETV therapy subgroup had a
significantly higher HBV DNA negative rate than ADV therapy subgroup at week 48 (90.3% vs 59.5%, χ2=8.255, P=0.004). At
week 72, 39.7%(27/68) of the patients in group A achieved HBeAg seroconversion, a rate significantly higher than those in
groups B (χ2=4.238, P=0.040) and C (χ2=7.681, P=0.006); the HBV DNA negative rate and ALT normalization rate in group A
were 85.3%(58/68) and 86.8%(59/68), respectively, both significantly higher than those in group B (χ2=23.018, P<0.001; χ2=5.987,
P=0.014) but comparable to those in group C (P>0.05). In the two subgroups in group A, the HBV DNA negative rate and
HBeAg seroconversion rate were both significantly higher in ETV subgroup (χ2=9.823, P=0.002; χ2=5.450, P=0.020). In group D,
all the patients remained HBeAg-positive with abnormal ALT levels and high level of HBV DNA. Conclusion For HBeAg-positive CHB patients with
suboptimal response to 24-week interferon monotherapy, combined treatment with NAs (especially ETV) and extension of the treatment
course can significantly improve the HBeAg seroconversion rates, HBV DNA negative rates, and ALT normalization rates.