1 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
2 Toronto Centre for Liver Disease, Toronto Western & General Hospital, University of Toronto, Toronto, Canada
3 Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
* Correspondence to:
Prof. H.L.A. Janssen, Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network, 399 Bathurst Street, 6B FP Room 164, Toronto, ON M5T 2S8, Canada.
E-mail: [email protected]
This article was accepted for publication after full peer-review.
Publication History
Issue published online: 2 APR 2015
Article first published online: 5 MAR 2015
Manuscript Accepted: 12 FEB 2015
Manuscript Revised: 10 FEB 2015
Manuscript Revised: 6 JAN 2015
Manuscript Revised: 17 NOV 2014
Manuscript Received: 22 OCT 2014
Funded by
Foundation for Liver and Gastrointestinal Research
Summary
Background
Before stopping nucleos(t)ide analogue (NA) treatment in chronic hepatitis B (CHB), 6–12 months of consolidation therapy is recommended.
Aim
To investigate the effect of consolidation therapy on off-treatment outcomes in CHB patients.
Methods
We included 94 patients who stopped NA after at least 1 year of therapy. Patients could be HBeAg-positive or HBeAg-negative at start-of-treatment, but were HBeAg-negative and had undetectable HBV DNA at time of discontinuation. Consolidation therapy was defined as treatment after the first undetectable HBV DNA (and HBeAg loss for HBeAg-positive patients) until NA cessation.
Results
At 3 years, 74% of the start-of-treatment HBeAg-positive and 75% of the start-of-treatment HBeAg-negative patients developed HBV DNA >2000 IU/mL at a single time point, whereas a persistent virological relapse (≥2 tests of HBV DNA >2000 IU/mL 6 months apart within 1 year) developed in 49% of the start-of-treatment HBeAg-positive and 53% of the start-of-treatment HBeAg-negative patients. For both HBeAg-positive and HBeAg-negative patients, consolidation therapy of ≥3 years was associated with lower persistent virological relapse rates compared to <1 year (1-year relapse rate: 25% vs. 54%; P = 0.063 and 24% vs. 57%; P = 0.036, respectively). At 3 years, 9% of the HBeAg-positive and 14% of the HBeAg-negative patients became HBsAg-negative. Prolonged consolidation therapy increased the likelihood of HBsAg loss. Two cirrhotic patients developed hepatic decompensation but both recovered.
Conclusions
After nucleos(t)ide analogue discontinuation, relapse was common in patients with chronic hepatitis B. Prolongation of consolidation therapy beyond 3 years decreased the risk of persistent virological relapse and increased the likelihood of HBsAg loss.
作者: StephenW 时间: 2015-4-3 19:29
复发的长期的核苷（酸）类似物IDE巩固治疗慢性乙型肝炎后风险降低
H. Chi1，BE Hansen1，C. Yim2，P. Arends1，M.阿布 - Amara2，AA范德Eijk3，JJ Feld2，RJ德Knegt1，DKH Wong2 andH。 L. A. Janssen1,2，*