Withdrawal of Nucleos(t)ide Analogues in Hepatitis B e Antigen-Negative Patients: An Asian Perspective
Tung-Hung Su 1 2 3 , Jia-Horng Kao 1 2 3 4 5
Affiliations
Affiliations
1
Division of Gastroenterology and Hepatology Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan.
2
Department of Internal Medicine National Taiwan University College of Medicine Taipei Taiwan.
3
Hepatitis Research Center National Taiwan University Hospital Taipei Taiwan.
4
Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan.
5
Department of Medical Research National Taiwan University Hospital Taipei Taiwan.
PMID: 33489096 PMCID: PMC7805293 DOI: 10.1002/cld.950
Chronic hepatitis B virus (HBV) infection is currently incur-able. Long-term treatment with potent and safe nucleos(t)ide analogues (NAs) can reduce hepatocellular carcinoma (HCC), cirrhotic complications, and liver-related mortality through substantial viral suppression.1 However, long-term therapy raises several crucial issues with pros and cons. Because hepatitis B surface antigen (HBsAg) seroclearance or functional cure is not easily achievable, a finite therapy may provide an opportunity to facilitate HBsAg seroclearance by the rejuvenation of exhausted immune cells. However, the virological relapse (VR) or surge of alanine aminotransferase (ALT) levels may increase the risk for adverse outcomes (e.g., decompensation, fibrosis progression, HCC, or liver-related mortality) before HBsAg seroclearance, which are the safety concerns of finite therapy. Little is known about whether repeated therapeutic interruption will increase the chance of drug resistance, whereas the reduction of renal function and bone mineral density are the safety issues of infinite therapy. Lastly, the practice of “to stop” or “to continue” therapy should also consider the accessibility and affordability of thehealth care system. Patients who stop therapy need to be monitored closely with frequent virological and biochemical tests in the first year, especially if they experience a VR or clinical (biochemical) relapse (CR) (Table 1). About 40% of patients who stop NA therapy eventually receive retreatment.2 The cost-effective analysis should thus be performed on the basis of individual regions.作者: StephenW 时间: 2021-1-26 15:54