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399
Early Quantitative Response of Hepatitis
B Surface Antigen Is Associated with
Seroclearance in Patients with Chronic
Hepatitis B during Nucleot(s)Ide Analog
Therapy
Murata Ayato1, Takuya Genda1, Sho Sato1, Nozomi Amano1,
Hironori Tsuzura1, Ko Tomishima1, Shunsuke Sato1, Kohei
Matsumoto1, Yuji Shimada1, Masashi Mori2 and Katsuyori
Iijima1, (1)Juntendo University Shizuoka Hospital, (2)
Fujinomiya City General Hospital
Background: Seroclearance of hepatitis B surface antigen
(HBsAg) is considered to be associated with favorable clinical
outcomes, and is thought to be an ideal end point of therapy
in patients with chronic hepatitis B (CHB). Till date, oral
administration of nucleot(s)ide analogues (NAs) has been
the most popular treatment strategy for patients with CHB
because of their excellent virologic efficacy and safety profile.
Long-term administration of NAs suppresses hepatitis B
virus replication in >95% of patients, resulting in biochemical
remission and histological improvement, including the
regression of cirrhosis. However, HBsAg seroclearance is
a rare event even with NA therapy, and factors associated
with HBsAg seroclearance have not been fully clarified. The
present study aimed to clarify the dynamics of quantitative
serum HBsAg levels and its association with HBsAg
seroclearance, in patients with CHB who received NA therapy.
Methods: This study retrospectively included 160 patients
with CHB who received NA therapy, between 2003 and 2015
at our hospital. Serum HBsAg levels were serially quantified
before and during treatment. Early response of serum
HBsAg level was estimated as the percentage of HBsAg
decline at 48 weeks after NA therapy initiation. Cumulative
incidences of HBsAg seroclearance were evaluated using
the Kaplan-Meier plot analysis and the log-rank test. The
factors associated with HBsAg seroclearance were analyzed
by Cox proportional hazards analysis. Results: During the
median follow-up time of 7.6 years (range: 1.1–13.1 years),
HBsAg seroclearance was observed in 6 of the 160 patients
(1.8%/7 years). Age > 65 years and early HBsAg response >
85% were identified as factors significantly associated with
HBsAg seroclearance. Early HBsAg response > 85% was
observed in 11 of 160 patients (6.9%). The 7-year cumulative
incidences of HBsAg seroclearance was 28.6% and 0.0% in
patients with and without early HBsAg response, respectively
(p < 0.001). Conclusion: Both age and early HBsAg
response were significant predictors of HBsAg seroclearance
in CHB patients during NA therapy. Early HBsAg response
can be considered as an alternative treatment target instead
of HBsAg seroclearance, in patients with CHB during NA
therapy.
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发表于 2018-10-15 08:56