Evaluation of pegylated interferon-α therapy efficacy in patients with inactive hepatitis B surface antigen carrier state

Objectives Chronic HBV infection remains a global health challenge, with many patients progressing to cirrhosis and hepatocellular carcinoma (HCC), while inactive HBsAg carriers (IHC) are considered stable but still at risk for disease progression.Design This study evaluated the efficacy and safety of PegIFNα-2b therapy in IHC and chronic hepatitis B (CHB) patients. A total of 359 patients were included, with 97 in the IHC group and 262 in the CHB group. The primary endpoint was HBsAg clearance, and the secondary endpoint was HBsAg seroconversion.Results PegIFNα-2b therapy led to significantly higher HBsAg clearance rates in IHC patients (36%) compared to CHB patients (24%) at week 36 (p = 0.028). Additionally, the IHC group showed higher HBsAg seroconversion rates (27% vs. 13%, p = 0.002) at week 36, and 31% achieved seroconversion at week 48, compared to 19% in the CHB group (p = 0.013). However, this significant difference in HBsAg clearance was not observed at week 48 (end of treatment). Subgroup analysis revealed that among IHC patients, those with baseline HBsAg <100 IU/mL had significantly higher clearance and seroconversion rates at week 48 compared to those with baseline HBsAg 100–1000 IU/mL.Conclusions These findings suggest that PegIFNα-2b therapy may offer therapeutic benefits in IHC patients, particularly those with lower baseline HBsAg levels, and should be considered as part of a broader strategy for HBV management.