Challenges With Stopping Long-term Nucleos(t)ide Analogue Therapy in Patients With Chronic Hepatitis B
K. Seng Liem
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
Adam J. Gehring
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Jordan J. Feld
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
McLaughlin-Rotman Centre for Global Health, Toronto, Ontario, Canada
Harry L.A. Janssen
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
The treatment goals for patients with chronic hepatitis B include improving quality of life and decreasing the risk of liver disease-related complications. These aims can be achieved with nucleos(t)ide analogue (NUC) therapy, which largely prevents liver failure, decreases the risk of hepatocellular carcinoma, and has excellent safety data.1,2 Yet low rates of on-therapy functional cure (hepatitis B surface antigen [HBsAg] loss), which is regarded as the optimal end point to withdraw therapy, preclude many patients from stopping therapy. Additionally, other concerns of long-term therapy such as adherence, side effects, and, particularly, costs, spurred a worldwide scientific debate on NUC discontinuation before patients reach functional cure.
Although all major chronic hepatitis B guidelines have included recommendations on NUC withdrawal, these considerations are based on limited evidence and may underestimate sequelae of clinically significant flares.3, 4, 5 Recommendations differ on which patients can discontinue NUC treatment, when to restart treatment and what the optimal duration of consolidation therapy is. Some reasons for the lack of consensus are economical or practical, but arguably less scientific given the limited data available. Could the guidelines have concluded too prematurely that patients can stop NUC therapy?作者: StephenW 时间: 2020-3-25 12:52