1853
Low serum HBsAg level predicts HBsAg seroclearance
and sustained response in chronic hepatitis B after stopping
oral NUCs
Apinya Leerapun, Piyakiat Pinyomahakul, Phuripong Kijdamrongthum,
Taned Chitapanarux, Satawat Thongsawat; Internal
Medicine, Chiang mai university, Chiangmai, Thailand
Background and Aims: The current international guidelines for
management of chronic hepatitis B (CHB) have no clear consensus
on when to stop treatment after long-term oral nucleos(t)ide
analogs (NUCs) therapy, as the ideal endpoint of HBsAg seroclearance
is rarely achieved, and relapse rate was very high. In
our patient cohort, we observe a group of persistent low HBsAg
level after long term treatment, so we choose to stop NUCs
in this patient group and follow to see their responses. Methods:
A total of 77 chronic hepatitis B patients (35 HBeAg-positive
and 42 HBeAg-negative at treatment starting point) who
received long-term oral NUCs for 61.86 ± 25.82 months with
HBeAg loss, normal ALT, undetectable HBV DNA, and HBsAg
level less than 3 logs IU/ml for more than 12 months, were
recruited. We stopped oral NUCs in all patients and did a
close follow up for at least 12 months. Sustained response is
defined as persistent normal ALT, HBV DNA less than 2,000
IU/ml, and no increase of HBsAg level. Results: After 12
months of follow up, 13% (10 of 77 patients), had cumulative
incidence of HBsAg seroclearance. For the remaining 67, half
(38 of 67, 56.7%) had sustained response. Retreatment rate is
significant higher in HBeAg-positive CHB who achieved only
HBe-loss, but not HBe-seroconversion (P<0.001). Serum HBsAg
level less than 2 logs IU/ml at the end of treatment correlated
well with a chance for of HBsAg seroclearance (multivariate
analysis HR=1.57, 95%CI=1.21-2.03, P=0.001). Type of
NUCs had no association with HBsAg seroclearance and sustained
response. Conclusions: A persistently low HBsAg level
can predict off-treatment durability in both HBeAg-positive who
achieved HBe-seroconversion, and HBeAg-negative patients
with long term NUCs therapy. Treatment stopping consideration
is worthwhile in such patient group.
Figure Percentages of sustained response and HBsAg loss
Disclosures:
The following people have nothing to disclose: Apinya Leerapun, Piyakiat Pinyomahakul,
Phuripong Kijdamrongthum, Taned Chitapanarux, Satawat Thongsawat