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HBsAg LEVELS AT THE END OF LONG-TERM THERAPY
(EOT) WITH NUCLEOS(T)IDE ANALOGUES (NA) AFFECT THE
OUTCOMES OF NON-CIRRHOTIC PATIENTS WITH HBEAGNEGATIVE
CHRONIC HEPATITIS B (CHBE-)
Margarita Papatheodoridi1, Emilia Hadziyannis2, Afroditi
Orfanidou1, Kalliopi Zachou3, Anastasia Kourikou2, Anastasia
Tzakou4, Spilios Manolakopoulos1,2, George N. Dalekos3,
Stephanos J. Hadziyannis4 and George V Papatheodoridis1,
(1)Department of Gastroenterology, Medical School of
National and Kapodistrian University of Athens, General
Hospital of Athens “Laiko”, Athens, Greece, (2)2nd
Department of Internal Medicine, Medical School of National
and Kapodistrian University of Athens, General Hospital
of Athens “Hippokratio”, Athens, Greece, (3)Department
of Internal Medicine & Research Laboratory, Thessalia
University Medical School, (4)Liver Clinic, Athens, Greece
Background: EOT HBsAg serum levels have been
associated with subsequent HBsAg loss in non-cirrhotic
patients with CHBe- who discontinue long-term NA However,
their prognostic value for post-NA relapse or remission
remains unclear Thus, we assessed the rates of relapse,
retreatment and HBsAg loss in relation to EOT HBsAg levels
in a large cohort of non-cirrhotic CHBe- patients from 4
liver clinics in Greece Methods: We included 136 patients
(mean age at discontinuation: 58±12 years, males: 107/136)
who discontinued NA therapy after mean on-NA virological
remission of 6 5± 3 1 years and had at least 12 months of
post-NA follow-up Patients with coinfection, cirrhosis, cancer
or liver transplantation were excluded Patient characteristics
before therapy as well as ΑLT, HBV DNA and HBsAg levels
at EOT and post-NA were recorded Patients were divided
in 3 groups based on EOT HBsAg levels: Α:≤100 IU/mL,
B:>100-1000 IU/mL, C:>1000 IU/mL. Study endpoints were
virological relapse (HBV DNA>2000 IU/mL), clinical relapse
(HBV DNA>2,000 IU/mL & ALT>2ULN), retreatment and
HBsAg loss Results: Μean post-NA follow-up was 43±36
months The cumulative rates of virological relapse did not
differ significantly among patients of group A, B, C being 46%,
43%, 41% at 6 months and 50%, 64%, 74% at 12 months,
respectively (log-rank, P=0 39) In contrast, the cumulative
rates of clinical relapse were significantly different among
groups A, B, C being 16%, 34%, 31% at 6 months and 16%,
34%, 38% at 12 months, respectively (log-rank, P=0 05) The
cumulative rates of retreatment differed significantly between
group Α, Β, C being 8%, 24%, 28% at 6 months and 8%,
24%, 31% at 12 months, respectively (log-rank, P=0 01)
Only 2 cases of retreatment and one of virological relapse
were observed after 12 months Finally, the cumulative rates
of HBsAg loss also differed significantly among groups A, B,
C being 38%, 9%, 7% at 12 months and 64%, 15%, 12% at
36 months, respectively (log-rank, P<0 001) Conclusion: In
non-cirrhotic CHBe- patients who discontinue long-term NA
therapy, the outcomes differ significantly according to their
HBsAg levels at EOT. Patients with EOT HBsAg ≤100 IU/mL
have significantly lower risk of clinical relapse or retreatment
and higher probability of HBsAg loss; thus, such patients can
safely stop NA therapy and often achieve post-NA functional
cure (HBsAg loss).Yet, patients with EOT HBsAg >100 IU/
mL infrequently clear HBsAg within the first 3 years but the
majority of them remain without clinical relapse or need for
retreatment.作者: StephenW 时间: 2019-10-27 15:10