AASLD 2011:Low Incidence of Hepatitis B e Antigen (HBeAg) Seroconversion with Or

StephenW

AASLD Liver Meeting abstract: 1441. Low Incidence of Hepatitis B e Antigen
(HBeAg) Seroconversion with Oral Monotherapy in Chronic Hepatitis B (CHB)
Treatment-Naïve Patients at Year 1 in Clinical Practice B. Lin1; N. B.
Ha4, 1; A. Liu3; H. N. Trinh2, 1; H. A. Nguyen2; K. Nguyen2; R. T. Garcia2;
E. B. Keeffe4; G. Garcia4; A. Ahmed4; M. H. Nguyen4 1. Pacific Health
Foundation, San Jose, CA, United States. 2. San Jose Gastroenterology, San
Jose, CA, United States. 3. Department of Medicine, Stanford University
Medical Center, Stanford, CA, United States. 4. Division GI and Hepatology,
Stanford University Medical Center, Palo Alto, CA, United States.

Purpose: HBeAg seroconversion is a major goal for therapy of HBeAg+ CHB
patients and generally ranges 15-22% at year 1 in registration trials with
oral nucleos(t)ides. Similar results may not be achievable in routine
practice and the goal of this study was to determine the incidence and
predictors of HBeAg seroconversion in this setting.

Methods: We conducted a retrospective cohort study of 333 consecutive
HBeAg+ patients treated with oral nucleos(t)ides for CHB between 1/2000 and
6/2010 at 3 U.S. gastroenterology and liver clinics. Patients were divided
into two groups: Group I (n=25) - those who achieved HBeAg seroconversion
at year 1 and Group II (n=308) - those who did not seroconvert.

Results: Most patients were Asian (96%) and male (58-68%). Baseline
characteristics in both groups were comparable except for lower HBV DNA
levels in group I. Median treatment duration that led up to HBeAg
seroconversion was 50 (26-52) weeks. A total of 9.6% of the patients
experienced HBeAg loss and 8.2% achieved HBeAg seroconversion by year 1.
HBeAg seroconversion rates were not statistically different by the
different antiviral agents (7.4% in lamivudine, 12.6% in adefovir, 7.7% in
entecavir and 4.8% tenofovir, p=0.59) (Figure 1). On multivariate analysis
inclusive of age, gender and antiviral agents, independent predictors for
HBeAg seroconversion at year 1 were HBV DNA < 7.5 log10 IU/mL and ALT > 1.5
ULN (HR=2.59, p=0.041 and 2.86, p=0.040, respectively).

Conclusions: HBeAg seroconversion rates in clinical settings are lower than
those reported in registration trials, especially those with lower ALT and
higher HBV DNA levels. HBeAg+ patients should be counseled about the
possibility that long-term treatment may be required to achieve HBeAg
seroconversion.

StephenW

肝病学会肝会议摘要：1441。乙型肝炎e抗原的低发病率
e抗原（HBeAg）血清转换与口服单一疗法在慢性乙型肝炎（CHB）
在临床实践B.林1中治疗过的患者在1年;注意：
Ha4，1;刘答：3; 1 HN Trinh2，医管局Nguyen2 K.阮2，RT Garcia2;
EB Keeffe4; G.加西亚4，A.艾哈迈德4，MH Nguyen4 1。太平洋健康
基金会，美国加利福尼亚州圣何塞，。 2。圣何塞消化科，圣
圣何塞，美国。 3。斯坦福大学医学系，
医疗中心，斯坦福大学，加州，美国。 4。部胃肠道和肝脏，
斯坦福大学医学中心，帕洛阿尔托，加利福尼亚，美国。

目的：HBeAg血清转换的HBeAg +慢性乙型肝炎治疗的一个主要目标
患者和一般为15-22％的登记试验，在今年1
口服核苷（酸）IDES。类似的结果可能不会在常规实现
实践和这项研究的目的是确定发病率和
预测在此设置的HBeAg血清转换。

方法：我们进行了一项回顾性队列研究连续333
大三阳患者治疗口腔nucleos（T）对慢性乙型肝炎的IDE之间的1 / 2000的
6 / 2010年在美国胃肠病学和肝病诊所。患者分为
分为两组：I组（N = 25） - 那些实现HBeAg血清转换
在第1年和第II组（N = 308） - 谁也不能seroconvert。

结果：大多数患者是亚洲（96％）和男性（58-68％）。基线
在这两个群体的特点相媲美，除了降低HBV DNA的
在第一组平均治疗时间，导致了以HBeAg的水平
血清转换是50（26-52）周。共有9.6％的患者
经验丰富的HBeAg消失和8.2％，1年实现HBeAg血清转换。
HBeAg血清转换率没有统计学的不同
不同的抗病毒药物（7.4％，拉米夫定，阿德福韦的12.6％，7.7％
恩替卡韦和4.8％泰诺福韦，P = 0.59）（图1）。在多变量分析
包括年龄，性别和抗病毒药物，独立预测
在今年1 HBeAg的血清转换是HBV - DNA <7.5 log10的IU / mL和ALT> 1.5
ULN（HR = 2.59，P = 0.041，P = 0.040和2.86，分别）。

结论：在临床上HBeAg的血清转换率都低于
报告在登记试验，特别是那些较低的ALT和
较高的HBV DNA水平。大三阳+的患者，应劝告有关
可能性，可能需要长期治疗达到HBeAg的
血清转换。