Long-term Clinical Outcomes after Withdrawal of Nucleos(t)ide Analogues in Patients with Chronic Hepatitis B
The management strategy of chronic hepatitis B in patients treated with nucleos(t)ide analogues (NAs) is a topic of concern.After achieving specific endpoints, the outcome after withdrawal of NAs was evaluated.Between 2002 and 2009, a total of 155 patients who achieved hepatitis B surface antigen (HBsAg) loss, hepatitis B e antigen (HBeAg) seroconversion (for HBeAg-positive patients), or maintained undetectable HBV DNA (for HBeAg-negative patients) and had discontinued treatment for at least 96 weeks were included in the study.HBV DNA and alanine aminotransferase (ALT) level were monitored regularly after withdrawal of treatment.Relapse was determined by twice continuous HBV DNA over 200 IU/mL and ALT over 2 time upper limits of normal.The median duration of consolidation treatment was 120 weeks (interquartile range, 72-144 weeks), 96 weeks (interquartile range, 48-144 weeks) in HBeAg-positive patients and 144 weeks (interquartile range, 96-168 weeks) in HBeAg-negative patients.Among the 155patients, 24 (16%) demonstrated evidence of relapse (8% of HBeAg-positive and 28% of HBeAg-negative, P<0.01).No relapse was observed in HBsAg loss patients.Most of relapses occurred within 96 weeks of withdrawal.The median duration of relapse was 36 weeks (interquartile range, 13-48 weeks).Elevation of HBV DNA and ALT level over baseline was only observed in approximately 10% of relapse patients.There was no significant difference of the baseline characteristic (sex, HBV genotype, age, medicine, or ALT level) and duration of treatment between relapse patients and sustained response patients.NAs withdrawal is feasible after achieving some specific endpoints.Prolonging time of consolidation treatment in HBeAg-positive patients and maintaining consistent undetectable HBV DNA in HBeAg-negative patients are effective strategy to reduce the relapse rate after withdrawal.More than 96 weeks of sustained response after withdrawal is a predictive marker for long-term sustained response.
Dengming He Xianli Chen Guohua Yan Jie Wang Maoshi Li Shimin Guo Peng Zhu Hongfei Huang Yuming Wang
Institute of Infectious Diseases, Southwest Hospital, Third Military Medical University,Chongqing, China
国内会议
重庆
英文
96-108
2013-08-29（万方平台首次上网日期，不代表论文的发表时间）