Background/Aims: Guidelines of major liver associations recommend that nucleot(s)ide analogue (NA) therapy should usually be continued indefinitely in chronic hepatitis B patients with decompensated cirrhosis. However, there is no evidence to support this recommendation. We therefore examined this issue using an earlier lamivduine treated cohort to study the outcomes of stopping NA therapy.
Methods: The study patients included 280 patients with decompensated chronic hepatitis B (228 males; 115 cirrhosis) who were treated with lamivudine 100mg/day for 1-50 months and were followed-up after cessation of therapy for at least 12 months. Their baseline features are listed in Table. After stopping therapy, they were monitored every 1-3 in the first 6 months and then every 3-6 months. The incidence of off-therapy events including hepatic decompensation (DE), hepatocellular carcinoma (HCC) and mortality were compared between cirrhotic and non-cirrhotic patients using Kaplan-Meier estimates.
Results: Events occurred in 24.64 % of the patients during a follow-up period of 12-180 (median:89.1) months after stopping therapy, including 55 DE (16%), 18 HCC (6.4 %) and 3 mortalities (1.1 %). The incidence of DE, HCC and mortality remained low in cirrhotic patients though significantly higher than that of non-cirrhotic counterparts (Table).
Conclusion: The results of this retrospective study show that NA can be stopped safely in the majority of patients who were successfully rescued by NA therapy, even in cirrhotic patients. Proper off therapy monitoring is mandatory.作者: 咬牙硬挺 时间: 2013-11-17 10:25