EASL 2013(推荐):停止长期的核苷（T）IDE类似物治疗HBeAg阴性CHB

StephenW

Abstract 770
     
STOPPING LONG-TERM NUCLEOS(T)IDE ANALOGUE THERAPY BEFORE HBSAG LOSS IN HBEAG NEGATIVE CHB PATIENTS: FOLLOW-UP OF LONG TERM RESPONDERS
     
J. Petersen1*, P. Buggisch1, H. Hinrichsen2, T. Berg3, H. Wedemeyer4, M. Cornberg4, A. Stoehr1
1Liver Unit, IFI Institute for Interdisciplinary Medicine, Asklepios Clinics St. Georg Hamburg, Hamburg+, 2Gastroenterology, Gastroenterologische Schwerpunkt Praxis, Kiel, 3Gastroenterology and Hepatology, University of Leipzig, Leipzig, 4Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany. *[email protected]

Background and aim: Long-term treatment with nucleos(t)ide analogues (NUC) is highly effective but HBsAg loss is a rare event in HBeAg-negative patients. Small pilot trials have challenged the question of sustained remission after discontinuation of long-term NUC-therapy in some patients. We recently reported on high relapse rates (72%) after treatment discontinuation in 32 HBeAg-negative patients (AASLD 2011). Here we report on the long-term outcome of patients without HBV relapse after stopping antiviral treatment after 37-80 months.
Methods: 9/32 patients without relapse were identified by retrospective data base search. These patients were prospectively followed (median 24 months).
Results: All patients were HBeAg-negative, 7/9 male, median age 43 years, genotype A or D. Three patients had received lamivudine, two adefovir, one telbivudine, and three entecavir. At stopping treatment all responder patients showed qHBsAg levels of < 1000IU/ml, six lost HBsAg off therapy (at months 6, 9, 12, 14, 20, 28) and three of these developed anti-HBs (16, 18, 26 months after treatment termination). All nine patients showed an ongoing reduction of qHBsAg levels, demonstrated long-term normal or close to normal ALT-levels, with HBV-DNA ranging from undetectable levels to 6.9x103 log IU/ml. No patient displayed apparent liver disease progression by regular fibroscans, whereas a trend towards improvement (albeit not significant) could be detected.
Conclusion: Stopping long-term NUC therapy in HBeAg-negative CHB patients with non-advanced liver disease might be an option for patients with HBsAg titers < 1000IU/ml. These patients develop a high rate of HBsAg loss off-therapy and suggest that these patients may have developed some degree of immunological control of HBV during and off-treatment. Better immunological characterization of CHB patients with an indication for antiviral treatment is urgently needed to identify predictive markers to stop long-term NUC-therapy in some patients.


Assigned speakers:
Prof. Jorg Petersen, IFI Institute at the, Asklepios Klinik St Georg Hamburg , Hamburg , Germany

Assigned in sessions:
26.04.2013, 09:00-18:00, Poster Session, P02-07c, Category 07c: Viral Hepatitis B & D: Clinical (therapy, new compounds, resistance), Poster Area

StephenW

背景和目的：长期使用核苷（酸）类似物治疗（NUC）是非常有效的，但在HBeAg阴性患者HBsAg消失是一个罕见的事件。小试试验已经NUC-长期治疗在一些患者停药后持续缓解的问题提出质疑。最近，我们报道了32例HBeAg阴性患者（2011年AASLD）停止治疗后的高复发率（72％）。在这里，我们报告37-80个月后停止抗病毒药物治疗后乙肝复发患者没有长期的结果。
方法：9/32例患者无复发，确定追溯数据基本搜索。这些患者进行前瞻性随访（平均24个月）。
结果：所有患者HBeAg阴性，7/9男性，平均年龄43岁，A或D基因型患者曾接受拉米夫定，阿德福韦，替比夫定，恩替卡韦。在停止治疗表明，六<1000IU/ml水平qHBsAg所有应答患者失去了治疗乙肝表面抗原（6个月，9，12，14，20，28），这些发达的抗-HBs（16，18，26个月治疗后终止）。所有九个患者表现为一个持续的减少qHBsAg水平，表明长期正常或接近正常的ALT水平，HBV-DNA检测不到的水平的6.9x103日志IU /毫升不等。患者没有显示明显的肝的疾病进展定期fibroscans，而改善的趋势（尽管不显着），可检测。
结论：停止长期NUC治疗HBeAg阴性CHB患者与非晚期肝病患者的HBsAg滴度<1000IU/ml可能是一种选择。这些患者出现HBsAg消失率的治疗，并建议这些患者可能已经开发出一定程度的HBV免疫控制和关闭处理。更好的免疫学特性与抗病毒治疗指征的慢性乙型肝炎患者迫切需要确定国统会停止长期治疗的预测指标，在一些患者。