Off-treatment durability of antiviral response to nucleoside analogues in patients with chronic hepatitis B

• Published in: BMC gastroenterology Vol. 16; no. 38; p. 38
• Main Authors: Nagata, Naruhiko, Kagawa, Tatehiro, Hirose, Shunji, Arase, Yoshitaka, Tsuruya, Kota, Anzai, Kazuya, Shiraishi, Koichi, Mine, Tetsuya
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17-03-2016; BioMed Central
• Subjects: Adult; Alanine Transaminase - blood; Antiviral Agents - therapeutic use; Carcinoma, Hepatocellular - epidemiology; Care and treatment; Cohort Studies; Development and progression; Disease Progression; DNA, Viral - blood; Female; Follow-Up Studies; Gastroenterology; Guanine - analogs & derivatives; Guanine - therapeutic use; Health aspects; Hepatitis B; Hepatitis B e Antigens - blood; Hepatitis B Surface Antigens - blood; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - drug therapy; Humans; Inflammation; Lamivudine; Lamivudine - therapeutic use; Liver Neoplasms - epidemiology; Male; Middle Aged; Polymerase Chain Reaction; Recurrence; Remission Induction; Retrospective Studies; Reverse Transcriptase Inhibitors - therapeutic use; Risk factors; Viral Load; Durability; Hepatocellular carcinoma; Nucleoside analogue; Chronic hepatitis B; HBs antigen
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-016-0454-z

Off-treatment durability of nucleoside analogue (NA) therapy in patients with chronic hepatitis B has not been well investigated. In this study we monitored antiviral effect of NA therapy and evaluated off-treatment durability after NA cessation in patients with chronic hepatitis B.
A total of 94 consecutive patients (39 HBeAg-negative and 55 HBeAg-positive patients) who received NA therapy were followed up for approximately 9 years. We discontinued NA according to the following criteria; undetectable serum HBV-DNA by polymerase chain reaction (PCR) on three separate occasions at least 6 months apart in HBeAg-negative patients (APASL stopping recommendation), and seroconversion from HBeAg-positive to HBeAb-positive and undetectable serum HBV-DNA by PCR for at least 12 months in HBeAg-positive patients.
The cumulative rate of relapse after NA cessation was 48 % and 40 % in HBeAg-negative and -positive patients, respectively. Higher baseline serum alanine aminotransferase level was the only significant predictor for maintaining remission. No patients experienced decompensation after relapse. HBsAg loss occurred at an annual rate of 1.4 % and 0.4 % in HBeAg-negative and -positive patients, respectively. Hepatocellular carcinoma developed at an annual rate of 0.6 % in both HBeAg-negative and -positive patients.
Almost half of the patients did not relapse after cessation of NA therapy in both HBeAg-negative and -positive patients. Therefore, NA therapy could be discontinued with close monitoring if the APASL stopping recommendation is satisfied even in HBeAg-negative patients.