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COMMON HEPATITIS FLARE BUT RARE HBsAg
SEROCLEARANCE AFTER STOPPING NA TREATMENT IN
PATIENTS WITH HBEAG-NEGATIVE CHB PATIENTS
Grace L Wong1, Becky W.Y. Yuen2, Vicki Wing Ki Hui2, Yee-Kit
Tse1, Terry Cheuk-Fung Yip3, Lilian Yan Liang4, Henry Lik Yuen
Chan5 and Vincent Wai-Sun Wong6, (1)Institute of Digestive
Disease, Department of Medicine and Therapeutics, The
Chinese University of Hong Kong, (2)Department of Statistics,
The Chinese University of Hong Kong, (3)Department of
Medicine and Therapeutics, The Chinese University of Hong
Kong, (4)Department of Medicine and Therapeutics, Institute
of Digestive Disease, The Chinese University of Hong Kong,
(5)Institute of Digestive Disease, Department of Medicine
and Therapeutics, and State Key Laboratory of Digestive
Disease, The Chinese University of Hong Kong, Hong Kong,
(6)Department of Medicine and Therapeutics, The Chinese
University of Hong Kong, Hong Kong
Background: The rates of hepatitis B surface antigen (HBsAg)
seroclearance after stopping nucleos(t)ide analogues (NA)
treatment in European and Asian chronic hepatitis B (CHB)
patients are very different (19% in 2 years and 13% in 6
years respectively). We evaluated the incidences of hepatitis
flare and HBsAg seroclearance in a cohort of 1,076 HBeAgnegative
Chinese CHB patients Methods: This was a
territory-wide retrospective observational cohort study in
Hong Kong. We identified HBeAg-negative CHB patients
through the Clinical Data Analysis and Reporting System
(CDARS) based on the drug record of NA from January
2000 to December 2017 who had stopped NA treatment
for more than 3 months. Hepatitis flare was defined as ALT
>2xULN. Results: The 1,076 patients were predominantly
middle-aged men (mean age 52 years, male 74 8%; 8 3%
had compensated cirrhosis) at the time of starting NA; they
stopped NA after 82±35 months of treatment (80% entecavir,
16% tenofovir, 3% lamivudine) After stopping NA, 20 8% noncirrhotic
and 21.3% cirrhotic patients had hepatitis flare (with
7.6% and 11.2% ALT>5xULN); 31% and 16% had peak serum
HBV DNA >2000IU/mL; 13% and 32% INR>1.7; 47% and
95% total bilirubin>38μmol/L respectively. 71% non-cirrhotic
and 65% cirrhotic patients resumed NA treatment Only 10
(with 5 during NA retreatment) non-cirrhotic and one cirrhotic
patients had achieved HBsAg seroclearance Hepatic events
developed in 9 4% non-cirrhotic and 28 1% cirrhotic patients
at 9 5 ± 102 months after stopping NA Conclusion: Hepatitis
flare and retreatment were common in HBeAg-negative
CHB patients who stopped NA treatment; whereas HBsAg
seroclearance rarely occurred. Figure 1. Serial serum HBV
DNA results after stopping NA. 作者: StephenW 时间: 2019-10-28 16:38