Durability of Nucleos(t)ide Analogues Treatment in Patients With Chronic Hepatitis B.
Long-term nucleos(t)ide analogues (NUCs) treatment is usually required for patients with chronic hepatitis B (CHB). However, whether discontinuation of NUCs is possible in selected patients remains debated. The aim of this study was to assess the durability of NUCs and predictors of sustained response after cessation of NUCs.Ninety-three CHB patients (29 HBeAg-positive and 64 HBeAg-negative) from 2 medical centers in Taiwan with discontinuation of NUCs after a median of 3 years' treatment were retrospectively reviewed. Fifteen (51.7%) HBeAg-positive and 57 (89.1%) HBeAg-negative patients achieved APASL treatment endpoints. Virological relapse (VR) and clinical relapse (CR) were defined according to APASL guidelines.Achieving APASL endpoint was associated with longer median time to CR in HBeAg-positive patients, but not in HBeAg-negative cases. The cumulative 1-year VR and CR rates were 55.3% and 14.4% in HBeAg-positive patients, and 77.7% and 41.9% in HBeAg-negative patients, respectively. In HBeAg-negative patients, baseline HBV DNA >10 IU/mL was the only predictor of VR (hazard ratio [HR] = 2.277, P = 0.019) and CR (HR = 3.378, P = 0.014). HBsAg >200 IU/mL at the end of treatment (EOT) was associated with CR (HR = 3.573, P = 0.023) in patients developing VR. HBeAg-negative patients with low baseline viral loads and low HBsAg levels at EOT had minimal risk of CR after achieving APASL treatment endpoint (P = 0.016).The VR rate is high, but the risk of CR is low within 1 year with consolidation treatment after HBeAg seroconversion. Longer consolidation treatment to reduce the risk of VR should be considered in HBeAg-positive patients. As high risk of VR and CR, cessation of NUCs therapy could be considered only in selected HBeAg-negative patients.
From the Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital (I-CL, C-WS, H-CH, K-CL, Y-SH, C-LP, H-CL, Y-HH); Faculty of Medicine, National Yang-Ming University School of Medicine (I-CL, C-WS, H-CH, K-CL); Division of Gastroenterology, Shin Kong Wu Ho-Su Memorial Hospital (C-KS, H-CC, Y-HL, C-SC, Y-ML); Health Care Center, Taipei Veterans General Hospital (Y-JW); and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan (I-CL, C-WS, K-CL, Y-HH).
I-Cheng
IC
Lee
Cheuk-Kay
CK
Sun
Chien-Wei
CW
Su
Yuan-Jen
YJ
Wang
Hung-Chuen
HC
Chang
Hui-Chun
HC
Huang
Kuei-Chuan
KC
Lee
Yi-Shin
YS
Huang
Chin-Lin
CL
Perng
Yuh-Hwa
YH
Liu
Chian-Sem
CS
Chua
Yu-Min
YM
Lin
Han-Chieh
HC
Lin
Yi-Hsiang
YH
Huang
D000328:Adult; D000367:Age Factors; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000008:administration & dosage / Q000627:therapeutic use*; D009711:Nucleotides / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012737:Sex Factors; D013624:Taiwan
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D009705:Nucleosides; D009711:Nucleotides