Distinct relapse rates and risk predictors after discontinuing tenofovir and entecavir therapy
Tung-Hung Su Hung-Chih Yang Tai-Chung Tseng Jyh-Ming Liou Chen-Hua Liu Chi-Ling Chen Pei-Jer Chen Ding-Shinn Chen Chun-Jen Liu Jia-Horng Kao
The Journal of Infectious Diseases, jix690, https://doi.org/10.1093/infdis/jix690
Published:
02 January 2018
Abstract
Background
We investigated the patterns; predictors for virological relapse (VR), clinical relapse (CR), sustained clinical response (SCR); and retreatment outcomes after nucleos(t)ide analogue (NUC) therapy discontinuation.
Methods
Chronic hepatitis B patients discontinuing NUC were prospectively enrolled. Viral and host predictors, including HBsAg, anti-HBc, the single nucleotide polymorphisms of NTCP (rs2296651), CTLA4 (rs231775), rs3077 (HLA-DPA1), and rs9277535 (HLA-DPB1), and post-therapy predictors were investigated. Patients’ retreatments and outcomes were recorded.
Results
Overall, 100 patients discontinuing 3-year entecavir (ETV) or tenofovir (TDF) therapy were enrolled. Patients discontinuing TDF exhibited significantly higher 3-month VR (52.9% vs. 6.1%, P<0.001) and CR (15.2% vs. 1.5%, P=0.007) rates than those discontinuing ETV, but their 12-month relapse rates were comparable. The end-of-therapy HBsAg levels predicted VR (HR: 1.62; 95%CI: 1.19–2.21), CR (HR: 1.78, 95%CI: 1.13–2.81), and SCR (OR: 0.57, 95%CI: 0.35–0.94). The CTLA4 non-GG genotype predicted VR (HR: 1.74, 95%CI: 1.01–3.00) and CR (HR: 2.06, 95%CI: 1.04–4.11), while rs3077 AA genotype predicted SCR (OR: 10.84, 95%CI: 1.12–105). The 1-month HBV DNA level after NUC cessation is an early predictor of subsequent relapse.
Conclusions
TDF rather than ETV discontinuation is associated with an earlier relapse, and NUC-specific post-therapy monitoring is necessary. 作者: StephenW 时间: 2018-1-3 22:39