OUTCOME OF 3-YEAR CONSOLIDATION THERAPY FOLLOWING HBEAG LOSS IN HBEAG-POSITIVE CHRONIC HEPATITIS B PATIENTS TREATED WITH NUCLIOS(T)IDE ANALOGUES
Author(s): Ja Kyung Kim
, Kwan Sik Lee
, Jung Il Lee
, Ah Young Kang
, Hye Young Chang
Topic: Hepatitis B & D - clinical (therapy, new compounds, resistance)
Background and aims
The durability of response after stopping nucleos(t)ide analogue (NA) therapy in chronic hepatitis B (CHB) patients remains unknown. Although HBsAg loss is to be the ideal goal of NA treatment, it is scarcely achieved especially in HBV genotype C patients. The consolidation therapy before the discontinuation of NA is suggested to be at least one year although the ideal duration of consolidation therapy is yet to be validated. We studied the long term outcome of HBeAg positive CHB genotype C patients who discontinued NA therapy after 3 years of consolidation therapy.
Methods
We retrospectively studied the outcomes of 34 HBeAg positive CHB genotype C patients who stopped NA after achieving virological response, with HBeAg loss, and underwent 3-year consolidation therapy before stopping the treatment. Consolidation therapy was defined as NA treatment which was sustained after the first HBeAg loss with undetectable serum HBV DNA before NA discontinuation. Relapse was defined as HBV DNA >2,000 IU/mL measured twice at 6 months apart within one year, or retreatment after the initial HBV DNA elevation.
Results
NAs used at discontinuation were lamivudine (14.7%), lamivudine with adefovir (32.4%), adefovir(26.5%), clevudine (2.9%), telbivudine with adefovir (2.9%), or entercavir (20.6%). Median follow-up from the initial therapy and from the discontinuation after 3-year consolidation therapy was 112.7 (range 30.8-146.90) and 41.0 (range 7.6-60.8) months, respectively. The relapse was noted in 22 out of 34 patients within 5 years after stopping NA even with 3-year consolidation therapy. The cumulative relapse rate was 32.4% at 3 months, 35.3% at 6 months, 44.1% at 1 year, 47.1% at 3 years, and 64.7% at 5 years. After relapse, retreatment was started in 17 out of 22 patients (77.2%). All achieved virologic response to the retreatment. More than half (10/17, 58.8%) of the relapsed patients were resumed the treatment with previous NAs. Resistant rate was significantly higher in the relapse group than durable group (68.1% vs. 41.7%, p<0.05).
Conclusions
After 3-year consolidation therapy in HBeAg positive patinets, 64.7% of patients experienced a relapse within 5 years after the discontinuation of NA. This study suggests that CHB patients who discontinue therapy require close monitoring for recurrent hepatitis and restarting treatment especially in those with drug resistant mutation.
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Main topics 作者: StephenW 时间: 2016-4-26 17:53