1914
Durability of Nucleos(t)ide Analogues Treatment in Patients with Chronic Hepatitis B: The Role of APASL Guideline
Yi-Hsiang Huang1,2, I-Cheng Lee1,2, Cheuk-Kay Sun3, Chien-Wei Su1, Yuan-Jen Wang4, Han-Chieh Lin1;
1Division of Gastroenterol-ogy, Taipei Veterans General Hospital, Taipei, Taiwan; 2Institue of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; 3Division of Gastroenterology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Healthcare Center, Taipei Veterans General Hospital, Taipei, Taiwan
Background & Aims Whether new generation nucleos(t)ide analogues (NUCs) had better durability in suppressing hepatitis B virus (HBV) was unclear. The aim of this study was to assess the virological and clinical relapse rates and their predictors after NUCs treatment in chronic hepatitis B (CHB) patients.
Methods: From February 2012, consecutive 90 CHB patients (28 HBeAg-positive and 62 HBeAg-negative) from two medical centers in Taiwan receiving NUCs therapy (78% underwent entecavir treatment) were enrolled. All patients were monitored every 3 months with serum qHBsAg, HBV DNA and ALT after end of the treatment (EOT). Virological relapse (VR) was defined as an HBV DNA >2,000 IU/mL while clinical relapse (CR) was defined as HBVDNA >2,000 IU/mL plus ALT elevation >2× ULN. Results The 90 patients had received a median 156 weeks of NUCs treatments before EOT. Seventy patients (77.8%) achieved the recommended APASL treatment endpoint, including 15 (53.6%) HBeAg-positive and 55 (88.7%) HBeAg-negative patients. During the median follow-up period of 36.6 weeks (range 3 to 102 weeks), VR and CR developed in 71.1% and 37.8% of patients, respectively. In HBeAg-positive patients, the median time to VR and CR were 24.1 and 66.4 weeks, respectively. There was no significant predictor of VR, while achieving APASL treatment endpoint was the only predictor of CR (HR = 0.127, p = 0.014). In the 15 HBeAg-positive patients who achieved APASL treatment endpoint, 8 (53.3%) and 3 (20%) patients still developed VR and CR, respectively. In HBeAg-negative patients, the median time to VR and CR were 31.9 and 74.7 weeks, respectively. Neither achieving APASL treatment endpoint nor low qHBsAg level at EOT were not associated with VR and CR. In the 16 HBeAg-negative patients with HBsAg <200 IU/mL at EOT, 11 (68.8%) and 3 (18.8%) patients still developed VR and CR, respectively.
Conclusions The risk of VR is high after cessation of NUCs treatment even achieving APASL treatment endpoint in both HBeAg-positive and –negative CHB patients. Low HBsAg level at EOT could not confer relapse-free status. HBV viral load should be closely monitored for all patients after cessation of NUCs.
Disclosures:
The following people have nothing to disclose: Yi-Hsiang Huang, I-Cheng Lee, Cheuk-Kay Sun, Chien-Wei Su, Yuan-Jen Wang, Han-Chieh Lin 作者: StephenW 时间: 2014-10-31 14:47