长期的核苷（酸）类似物IDE巩固复发风险降低

StephenW

Reduced risk of relapse after long-term nucleos(t)ide analogue consolidation therapy for chronic hepatitis B


    H. Chi 1,
    B. E. Hansen 1,
    C. Yim 2,
    P. Arends 1,
    M. Abu-Amara 2,
    A. A. van der Eijk 3,
    J. J. Feld 2,
    R. J. de Knegt 1,
    D. K. H. Wong 2 and
    H. L. A. Janssen 1,2,*

Article first published online: 5 MAR 2015

DOI: 10.1111/apt.13150

© 2015 John Wiley & Sons Ltd

Issue
Cover image for Vol. 41 Issue 8
Alimentary Pharmacology & Therapeutics

Early View (Online Version of Record published before inclusion in an issue)
Article has an altmetric score of 1

    1    Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
    2    Toronto Centre for Liver Disease, Toronto Western & General Hospital, University of Toronto, Toronto, Canada
    3    Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands

* Correspondence to:
Prof. H.L.A. Janssen, Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network, 399 Bathurst Street, 6B FP Room 164, Toronto, ON M5T 2S8, Canada.
E-mail: [email protected]



Background

Before stopping nucleos(t)ide analogue (NA) treatment in chronic hepatitis B (CHB), 6–12 months of consolidation therapy is recommended.
Aim

To investigate the effect of consolidation therapy on off-treatment outcomes in CHB patients.
Methods

We included 94 patients who stopped NA after at least 1 year of therapy. Patients could be HBeAg-positive or HBeAg-negative at start-of-treatment, but were HBeAg-negative and had undetectable HBV DNA at time of discontinuation. Consolidation therapy was defined as treatment after the first undetectable HBV DNA (and HBeAg loss for HBeAg-positive patients) until NA cessation.
Results

At 3 years, 74% of the start-of-treatment HBeAg-positive and 75% of the start-of-treatment HBeAg-negative patients developed HBV DNA >2000 IU/mL at a single time point, whereas a persistent virological relapse (≥2 tests of HBV DNA >2000 IU/mL 6 months apart within 1 year) developed in 49% of the start-of-treatment HBeAg-positive and 53% of the start-of-treatment HBeAg-negative patients. For both HBeAg-positive and HBeAg-negative patients, consolidation therapy of ≥3 years was associated with lower persistent virological relapse rates compared to <1 year (1-year relapse rate: 25% vs. 54%; P = 0.063 and 24% vs. 57%; P = 0.036, respectively). At 3 years, 9% of the HBeAg-positive and 14% of the HBeAg-negative patients became HBsAg-negative. Prolonged consolidation therapy increased the likelihood of HBsAg loss. Two cirrhotic patients developed hepatic decompensation but both recovered.
Conclusions

After nucleos(t)ide analogue discontinuation, relapse was common in patients with chronic hepatitis B. Prolongation of consolidation therapy beyond 3 years decreased the risk of persistent virological relapse and increased the likelihood of HBsAg loss.
   

StephenW

复发的长期的核苷（酸）类似物IDE巩固治疗慢性乙型肝炎后风险降低

    H.志1，
    B. E.汉森1，
    C.任某2，
    P. ARENDS 1，
    M.阿布·阿马拉2，
    A. A.范德Eijk 3，
    J. J.费尔德2，
    R. J.德Knegt 1，
    D. K. H.皇2
    H. L. A.扬森1,2，*

文章首次在网上公布：2015年3月5日

DOI：10.1111 / apt.13150

©2015年约翰·威利父子有限公司

问题
封面图片的卷。 41第8
消化系统药理学与治疗学

早观（包含之前录制的网上版本出版中的问题）
第二十有altmetric比分1

    胃肠病学和肝病，伊拉兹马斯MC大学医学中心的鹿特丹，荷兰鹿特丹的1系
    2多伦多中心肝病，多伦多西部及综合医院，多伦多大学，加拿大多伦多
    Viroscience，伊拉兹马斯MC大学医学中心的鹿特丹，荷兰鹿特丹的3系

*通讯作者：
H.L.A.教授扬森，多伦多中心肝病，多伦多西部和综合医院，大学健康网络，399巴瑟斯特街，6B FP 164室，多伦多，ON M5T 2S8，加拿大。
电子邮件：[email protected]



背景

前停止核苷（酸）类似物IDE（NA）治疗慢性乙型肝炎（CHB），6-12个月的巩固治疗建议。
目的

调查巩固治疗对非治疗结果慢性乙型肝炎患者的效果。
方法：

我们包括谁至少1年的治疗后停止NA 94例。患者可能是HBeAg阳性或HBeAg阴性启动时的治疗，但均HBeAg阴性和检测不到HBV DNA的终止时间。巩固治疗被定义为治疗第一检测不到HBV DNA（和HBeAg损失HBeAg阳性患者），直到NA停止后。
结果

HBeAg阳性和发展HBV DNA> 2000 IU / mL的单个时间点启动治疗HBeAg阴性患者的75％，而持续的病毒学复发启动治疗的3年中，74％（ HBV DNA> 2000 IU / mL的相隔6个月1年以内）的≥2测试开发的起始治疗的HBeAg阴性患者的启动-治疗HBeAg阳性和53％，49％。 ; P = 0.063和24％，25％和54％：对于HBeAg阳性和HBeAg阴性患者，≥3年的巩固治疗与比<1年（1年复发率较低的持续病毒学复发率相关与57％; P = 0.036，分别）。 3年，9％的HBeAg阳性和的HBeAg阴性患者14％成为乙肝表面抗原阴性。长期巩固治疗增加HBsAg消失的可能性。两个肝硬化患者发展为肝功能失代偿，但双方恢复。
结论

后核苷（酸）IDE类似物停药，复发是患者的巩固治疗慢性乙型肝炎的延长共同超越3年下降的持续病毒学复发的风险，并增加了HBsAg消失的可能性。

682256

看来只要HBsAg只要没loss，抗病毒时间越长越好！