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Viral Hepatitis
Discontinuation of oral antivirals in chronic hepatitis b: A systematic review
Authors
George Papatheodoridis1,*, Ioannis Vlachogiannakos1, Evangelos Cholongitas2, Karsten Wursthorn3, Christos Thomadakis4, Giota Touloumi4 andJörg Petersen3
1 Academic Department of Gastroenterology, Medical School of National and Kapodistrian Uinversity of Athens, Laiko General Hospital of Athens, Greece
2 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Greece
3 IFI Institute at Asklepios Klinik St. Georg, University of Hamburg, Hamburg, Germany
4 Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian Uinversity of Athens, Greece
*Contact information: George Papatheodoridis, MD. Director of Academic Department of Gastroenterology, Medical School of National and Kapodistrian Uinversity of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma street, 11527 Athens, Greece. Telephone: +30 2107456315, Fax: +30 2107462601, email: [email protected]
Accepted manuscript online: 11 January 2016Full publication history
DOI: 10.1002/hep.28438View/save citation
Cited by: 0 articles Check for new citations
Article has an altmetric score of 8
Abstract
The possibility of safe discontinuation of therapy with nucleos(t)ide analogues (NAs) remains one of the most controversial topics in the management of chronic hepatitis B. Therefore, we systematically reviewed the existing data on NAs discontinuation in this setting and tried to identify factors affecting the probability of post-therapy remission. Literature search was performed in order to identify all published studies including patients who discontinued NAs in virological remission (VR) and were followed for ≥12 months thereafter. Twenty-five studies with 1716 patients were included. The pooled rates of durable VR remission were 51.4%, 39.3% and 38.2% at 12, 24 and 36 months after NAs discontinuation being relatively higher in initially HBeAg-positive (62.5%, 53.4%, 51.5%) than HBeAg-negative patients (43.7%, 31.3%, 30.1%) (P=0.064). The weighted probability of durable biochemical remission was 65.4% being numerically higher in HBeAg-positive than HBeAg-negative patients (76.2% vs 56.7%, P=0.130). The weighted probability of HBsAg loss was 2.0%. The rates of durable VR did not significantly differ according to the VR definition (HBV DNA <200, <2,000, <20,000 IU/ml) or duration of on-therapy VR in HBeAg-positive patients, but they were significantly higher in studies with HBeAg-negative patients and on-therapy VR >24 than ≤24 months (VR at 12 months off-NAs: 75.0% vs 35.6%, P=0.005). The weighted probability of durable HBeAg seroconversion was 91.9% and 88.0% at 12 and 24 months after NAs discontinuation without being affected by the duration of on-therapy VR or consolidation therapy (>6 months in all studies). In conclusion, durable VR seems to be feasible in a substantial proportion of patients who discontinue long-term NA therapy. On-therapy VR >24 months offers higher chances of off-NAs VR in patients with HBeAg-negative chronic hepatitis B. This article is protected by copyright. All rights reserved.
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发表于 2016-1-17 02:21
