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REAL WORLD SINGLE CENTER EXPERIENCE ON THE
EFFICACY OF STOPPING LONG TERM NUCLEOS(T)IDE ANALOG
THERAPY IN PATIENTS WITH CHRONIC HEPATITIS B
Hassan Azhari1, Alexandra Frolkis2, Abdel-Aziz Shaheen1,
Heidi Israelson1, Jacqueline Pinto1, Stephen E. Congly1,
Meredith A. Borman1, Alex Aspinall1, Laura M. Stinton1,
Mark Gordon Swain1, Kelly W Burak1, Samuel S Lee1,
Matthew Sadler1 and Carla S. Coffin1, (1)Gastroenterology &
Hepatology, University of Calgary, (2)Medicine, University of
Calgary
Background: Nucleos(t)ide analogs (NA) suppress hepatitis
B virus (HBV) replication but have minimal effect on the
intrahepatic HBV cccDNA template and rarely lead to HBsAg
loss, requiring prolonged therapy Although expert guidelines
recommend that HBeAg (+) patients may stop NA after
achieving HBeAg seroconversion and consolidation therapy,
many relapse with treatment cessation In HBeAg (-) chronic
hepatitis B (CHB) some studies report that NAs can be
safely stopped in non-cirrhotic patients with undetectable
HBV DNA and quantitative (q)HBsAg levels <100 IU/mL
This study aimed to determine baseline clinical factors that
are associated with off-treatment NA durability Methods: In
this observational cohort study conducted at the Liver Unit
of the University of Calgary in Calgary, AB, Canada, we
reviewed all NA treated patients who stopped long-term NA
therapy based on physician recommendation at our centre
Baseline characteristics including age, sex, ethnicity, HBV
infection profile, and liver stiffness by transient elastrography
(FibroScan®) were collected Data after stopping therapy
was collected as per standard of care (i e , qHBsAg, ALT,
HBV DNA) Categorical variables were compared using
Chi-squared and Fisher’s exact tests Continuous variables
were compared using Wilcoxon rank-sum tests Results:
Among 1,337 CHB patients on long-term NA, 47 stopped
therapy (29 8% Female, 78% East Asian, median age 56
years, range 18-74 years), 28/47 were on tenofovir disoproxil
fumarate, 16 on entecavir, and 3 on lamivudine (including 2
with adefovir combination) All were HBeAg (-) at the time of
NA discontinuation and 46/47 had undetectable HBV DNA
Median liver stiffness was 5 2 kPa (range 3 3-6 6kPa) Six
patients (qHBsAg at NA discontinuation 205, 147, 74, 21, 5 4,
2.3) restarted NA due to a virologic flare defined as HBV DNA
>2000IU/mL (median HBV DNA 4,663 IU/mL, range 265 –
152,043,102 IU/mL) and/or biochemical flare defined as ALT
>2xULN (ALT 208, 938, 1467, 139, 828, 149 respectively).
None developed hepatic dysfunction, and all responded to
restarting NA with suppressed HBV DNA Factors associated
with needing to restart NA included baseline HBeAg (+) status
pre-treatment (n=3; 50% in the relapse group; n=5; 12% in
the non-relapse group; p=0 004) and longer NA treatment
duration (median duration 12 4 years in the relapse group;
6 1 years in the non-relapse group, p=0 011) Age, sex, liver
stiffness, NA, ethnicity, and qHBsAg level at stopping were not
associated with relapse risk Our data suggests that patients
HEPATOLOGY, VOLUME 72, NUMBER 1 (SUPPL) AASLD ABSTRACTS (Oral) 21A
a Denotes AASLD Foundation Abstract Award Recipient
who experience a flare up do so within the first 6 months of
discontinuing NAs, and are less likely to have a flare up once
this period has passed safely Conclusion: Stopping longterm
NA is feasible in HBeAg negative CHB with qHBsAg
<100IU/mL, however severe ALT flares can occur warranting
close follow-up The majority of biochemical and virological
flares occur within the first 6 months of treatment cessation. 作者: StephenW 时间: 2020-10-19 12:07