New data presented showed that, for the first time, doctors can predict which hepatitis B patients treated with Pegasys (peginterferon alfa-2a) have the highest chance to achieve a positive treatment outcome and even a clinical cure1,2. The study results represent an important step forward, as some patients will now be able to feel confident during their Pegasys treatment about the likelihood of beating the disease.

Several studies at the major Asia-Pacific liver disease meeting (APASL) focused on measuring the decline in levels of a viral protein called surface or 's'-antigen, to provide insight into the likelihood of treatment success for patients treated with Pegasys. S-antigen clearance, considered a clinical cure, is associated with greatly reduced liver cancer, cirrhosis and an improved life expectancy3,4,5.

'In treating hepatitis B, we need to change mindsets and raise expectations so that patients and physicians are focused on achieving the best possible outcome clearance of the s-antigen. These new data show that measuring s-antigen decline throughout treatment can help determine success in the long-term. Doctors can now therefore make a strong case to certain patients that Pegasys treatment may provide treatment success or even a clinical cure,' said Dr Patrick Marcellin, Professor of Hepatology at the University of Paris and Head of the Viral Hepatitis Research Unit in Hôpital Beaujon, Clichy, France.

'Unlike anti-viral tablets for hepatitis B, which just reduce the number of viral copies, Pegasys also boosts the body's immune system and mobilises it to fight the disease,' commented William M. Burns, CEO Roche Pharmaceuticals Division. 'Due to these immune-stimulating effects, the number of patients treated with Pegasys who achieve a clinical cure has been shown to continue increasing for years after the end of treatment. This supports its use as a first-line therapy for hepatitis B.' Measuring success with Pegasys in the two types of hepatitis B

There are two types of patients with hepatitis B: those with early disease who still have the envelope or 'e'-antigen in their blood, and those who do not (called 'e-positive' and 'e-negative' disease, respectively). Although some of the treatment endpoints are different, s-antigen clearance is the ultimate goal of therapy in both types of hepatitis B.

All patients start off with e-positive disease. For e-positive patients, loss of the e-antigen after treatment, or 'e-seroconversion', signifies that therapy has worked well, and is a first important indicator of treatment success. In a new study looking at e-positive patients, the results showed that 50% of patients whose s-antigen levels dropped significantly 24 weeks after starting Pegasys treatment were able to achieve 'e-seroconversion', an important treatment endpoint for these patients. Furthermore, approximately 20% of the patients with e-seroconversion went on to achieve s-antigen clearance, a so-called 'clinical cure', six months after treatment had ended.2

In some patients, after many years of infection, the virus mutates and no longer produces the e-antigen; these patients are considered e-negative. In this form of the disease, the virus evades the body's immune system so that the infection and liver damage return.

According to another new study presented at APASL, the number of e-negative hepatitis B patients who achieved a clinical cure continued to increase, even after the end of treatment with Pegasys.1 At year five, 12.2% of Pegasys-treated patients had cleared s-antigen, compared with just 3.5% of lamivudine-treated patients. Whilst modest, the number of patients who achieve s-antigen clearance on Pegasys therapy is a breakthrough because such high rates of s-clearance have never been shown with an oral anti-viral.1 Furthermore, researchers observed that s-antigen decline during treatment was associated with the achievement of a clinical cure.1