年的巩固治疗观察下列具有NUCLIOS（T）治疗的HBeAg阳性慢性乙

StephenW

OUTCOME OF 3-YEAR CONSOLIDATION THERAPY FOLLOWING HBEAG LOSS IN HBEAG-POSITIVE CHRONIC HEPATITIS B PATIENTS TREATED WITH NUCLIOS(T)IDE ANALOGUES
Author(s): Ja Kyung Kim
, Kwan Sik Lee
, Jung Il Lee
, Ah Young Kang
, Hye Young Chang

Topic: Hepatitis B & D - clinical (therapy, new compounds, resistance)

Background and aims
The durability of response after stopping nucleos(t)ide analogue (NA) therapy in chronic hepatitis B (CHB) patients remains unknown. Although HBsAg loss is to be the ideal goal of NA treatment, it is scarcely achieved especially in HBV genotype C patients. The consolidation therapy before the discontinuation of NA is suggested to be at least one year although the ideal duration of consolidation therapy is yet to be validated. We studied the long term outcome of HBeAg positive CHB genotype C patients who discontinued NA therapy after 3 years of consolidation therapy.

Methods
We retrospectively studied the outcomes of 34 HBeAg positive CHB genotype C patients who stopped NA after achieving virological response, with HBeAg loss, and underwent 3-year consolidation therapy before stopping the treatment. Consolidation therapy was defined as NA treatment which was sustained after the first HBeAg loss with undetectable serum HBV DNA before NA discontinuation. Relapse was defined as HBV DNA >2,000 IU/mL measured twice at 6 months apart within one year, or retreatment after the initial HBV DNA elevation.

Results
NAs used at discontinuation were lamivudine (14.7%), lamivudine with adefovir (32.4%), adefovir(26.5%), clevudine (2.9%), telbivudine with adefovir (2.9%), or entercavir (20.6%). Median follow-up from the initial therapy and from the discontinuation after 3-year consolidation therapy was 112.7 (range 30.8-146.90) and 41.0 (range 7.6-60.8) months, respectively. The relapse was noted in 22 out of 34 patients within 5 years after stopping NA even with 3-year consolidation therapy. The cumulative relapse rate was 32.4% at 3 months, 35.3% at 6 months, 44.1% at 1 year, 47.1% at 3 years, and 64.7% at 5 years. After relapse, retreatment was started in 17 out of 22 patients (77.2%). All achieved virologic response to the retreatment. More than half (10/17, 58.8%) of the relapsed patients were resumed the treatment with previous NAs. Resistant rate was significantly higher in the relapse group than durable group (68.1% vs. 41.7%, p<0.05).

Conclusions
After 3-year consolidation therapy in HBeAg positive patinets, 64.7% of patients experienced a relapse within 5 years after the discontinuation of NA. This study suggests that CHB patients who discontinue therapy require close monitoring for recurrent hepatitis and restarting treatment especially in those with drug resistant mutation.

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StephenW

3年的巩固治疗观察下列具有NUCLIOS（T）治疗的HBeAg阳性慢性乙型肝炎患者IDE类似物HBeAg消失
作者（S）：JA金炅
，关锡利
，郑日李
，赵雅英康
，惠英昌

主题：乙型肝炎＆D - 临床（治疗，新的化合物，电阻）

背景和目的
慢性乙型肝炎（CHB）患者停药核苷（酸）类似物IDE（NA）治疗后反应的持久性仍是未知。虽然HBsAg消失是要NA治疗的理想目标，但几乎尤其是在HBV C基因型患者达到。 NA的停止前的巩固治疗建议是至少一年虽然巩固治疗的理想持续时间尚未进行验证。我们研究谁在3年后的巩固治疗停药NA治疗HBeAg阳性慢性乙肝C基因型患者的长期预后。

方法
回顾性分析34谁获得病毒学应答，与HBeAg消失后停止NA HBeAg阳性CHB C基因型患者的预后，并停止用药前接受3年的巩固治疗。巩固治疗被定义为NA治疗这是NA停药前检测不到血清HBV DNA第一HBeAg消失后持续。复发定义为HBV DNA> 2000 IU / mL的一年内，相隔6个月测量两次，或者最初的HBV DNA升高后，再治疗。

结果
在停药使用结果：NAS拉米夫定（14.7％），拉米夫定阿德福韦（32.4％），阿德福韦（26.5％），克拉夫定（2.9％），替比夫定阿德福韦（2.9％），或entercavir（20.6％）。从最初的治疗和后3年的巩固治疗停药中位随访时间分别为112.7（范围30.8-146.90）和41.0（范围7.6-60.8）个月。复发于22停止NA甚至3年的巩固治疗后指出，满分5年内34例。累积复发率为3个月时32.4％，在6个月35.3％，1年为44.1％，3年为47.1％，并在5年时为64.7％。复发后，复治17出的22例（77.2％）已启动。所有取得病毒学应答的再治疗。的复发患者超过半数（10/17，58.8％）的恢复与以往的NAS治疗。耐药率较耐用组（68.1％对41.7％，P <0.05），复发组显著高。

结论
HBeAg阳性patinets 3年的巩固治疗后，患者的64.7％，经历了5年之内复发NA的停药后。这项研究表明，谁停止治疗的慢性乙肝患者需要经常性肝炎和重新启动处理尤其是在那些有耐药突变密切监测。