AASLD2016[1853]低血清HBsAg水平预测HBsAg血清清除率 和慢性乙型肝

StephenW

1853
Low serum HBsAg level predicts HBsAg seroclearance
and sustained response in chronic hepatitis B after stopping
oral NUCs
Apinya Leerapun, Piyakiat Pinyomahakul, Phuripong Kijdamrongthum,
Taned Chitapanarux, Satawat Thongsawat; Internal
Medicine, Chiang mai university, Chiangmai, Thailand
Background and Aims: The current international guidelines for
management of chronic hepatitis B (CHB) have no clear consensus
on when to stop treatment after long-term oral nucleos(t)ide
analogs (NUCs) therapy, as the ideal endpoint of HBsAg seroclearance
is rarely achieved, and relapse rate was very high. In
our patient cohort, we observe a group of persistent low HBsAg
level after long term treatment, so we choose to stop NUCs
in this patient group and follow to see their responses. Methods:
A total of 77 chronic hepatitis B patients (35 HBeAg-positive
and 42 HBeAg-negative at treatment starting point) who
received long-term oral NUCs for 61.86 ± 25.82 months with
HBeAg loss, normal ALT, undetectable HBV DNA, and HBsAg
level less than 3 logs IU/ml for more than 12 months, were
recruited. We stopped oral NUCs in all patients and did a
close follow up for at least 12 months. Sustained response is
defined as persistent normal ALT, HBV DNA less than 2,000
IU/ml, and no increase of HBsAg level. Results: After 12
months of follow up, 13% (10 of 77 patients), had cumulative
incidence of HBsAg seroclearance. For the remaining 67, half
(38 of 67, 56.7%) had sustained response. Retreatment rate is
significant higher in HBeAg-positive CHB who achieved only
HBe-loss, but not HBe-seroconversion (P<0.001). Serum HBsAg
level less than 2 logs IU/ml at the end of treatment correlated
well with a chance for of HBsAg seroclearance (multivariate
analysis HR=1.57, 95%CI=1.21-2.03, P=0.001). Type of
NUCs had no association with HBsAg seroclearance and sustained
response. Conclusions: A persistently low HBsAg level
can predict off-treatment durability in both HBeAg-positive who
achieved HBe-seroconversion, and HBeAg-negative patients
with long term NUCs therapy. Treatment stopping consideration
is worthwhile in such patient group.
Figure Percentages of sustained response and HBsAg loss
Disclosures:
The following people have nothing to disclose: Apinya Leerapun, Piyakiat Pinyomahakul,
Phuripong Kijdamrongthum, Taned Chitapanarux, Satawat Thongsawat

StephenW

AASLD2016 [1853]低血清HBsAg水平预测HBsAg血清清除率
和慢性乙型肝炎停止后持续反应
口服NUC
低血清HBsAg水平预测HBsAg血清清除率
和慢性乙型肝炎停止后持续反应
口服NUC
Apinya Leerapun，Piyakiat Pinyomahakul，Phuripong Kijdamrongthum，
Taned Chitapanarux，Satawat Thongsawat;内部
医学，清迈大学，清迈，泰国
背景和目的：目前的国际指南
慢性乙型肝炎（CHB）的管理没有明确的共识
在何时停止治疗长期口服核苷（t）ide
类似物（NUC）治疗，作为HBsAg血清清除的理想终点
很少实现，复发率非常高。在
我们的患者队列，我们​​观察到一组持续低HBsAg
水平经过长期治疗，因此我们选择停止NUC
在这个病人组，并按照看到他们的反应。方法：
共有77例慢性乙型肝炎患者（35例HBeAg阳性
和42 HBeAg阴性在治疗起点）谁
接受长期口服NUCs为61.86±25.82个月
HBeAg缺失，正常ALT，不可检测的HBV DNA和HBsAg
水平低于3 log IU / ml超过12个月，
招聘。我们停止所有患者口头NUCs，并做了
密切跟踪至少12个月。持续反应
定义为持续正常ALT，HBV DNA小于2,000
IU / ml，且HBsAg水平无增加。结果：12之后
几个月的随访，13％（77例患者中的10例），累积
HBsAg血清清除的发生率。剩下的67个，一半
（67例中的38例，56.7％）持续反应。再治疗率为
显着高于HBeAg阳性CHB，仅达到
HBe损失，但不是HBe血清转换（P <0.001）。血清HBsAg
水平低于2 log IU / ml在治疗结束时相关
以及有HBsAg血清清除的机会（多变量
分析HR = 1.57,95％CI = 1.21-2.03，P = 0.001）。类型
NUC与HBsAg血清清除无关并且持续
响应。结论：持续低的HBsAg水平
可以预测HBeAg阳性患者的治疗后耐久性
实现HBe血清转换和HBeAg阴性患者
与长期NUCs治疗。治疗停止考虑
是值得的在这样的患者组。
图表持续反应和HBsAg消失的百分比
披露：
以下人没有什么可披露：Apinya Leerapun，Piyakiat Pinyomahakul，
Phuripong Kijdamrongthum，Taned Chitapanarux，Satawat Thongsawat