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458B
HBsAg Kinetics Prior to HBsAg Loss after
Cessation of Entecavir Therapy in Hbeag-
Negative Chronic Hepatitis B Patients
Wen-Juei Jeng, Department of Gastroenterology and
Hepatology, Chang Gung Medical Foundation, Ming-Ling
Chang, College of Medicine, Chang Gung University;
Department of Gastroenterology and Hepatology, Chang
Gung Memorial Hospital, Linkou and Yun-Fan Liaw, Liver
Research Unit, Chang Gung Memorial Hospital
Background: Increasing evidence has shown that cessation
of nucleos(t)ide analogue (Nuc) therapy may increase HBsAg
seroclearance in HBeAg negative patients. End of treatment
(EOT) HBsAg<100 IU/mL and no re-treatment in patients with
sustained response and those with clinical relapse are two of
the strongest factors for subsequent HBsAg loss. However,
the HBsAg kinetics from EOT to HBsAg seroclearance is
unknown. The aim of the study is to investigate and compare
the HBsAg kinetics prior to HBsAg loss in these patients.
Methods: Among the 571 HBeAg negative patients who
stopped entecavir therapy, 26 patients with sustained
response (SR group) and 11 patients with clinical relapse
without retreatment (CR group) had achieved HBsAg loss
and had serial serum quantitative HBsAg (qHBsAg) data
till HBsAg seroclearance. They were included in this study.
Factors including age, gender, cirrhosis, hepatic steatosis,
treatment duration, qHBsAg at EOT and time to the start
of “precipitous HBsAg decline” (defined as > 0.5 log10IU/ml
in 1 year) were included in the analyses. Results: SR and
CR group had comparable age, gender, cirrhosis, fatty liver,
treatment duration, viral genotype while EOT qHBsAg was
significantly lower in the SR group [60 (0.6-817) vs. 355
(50-1914) IU/ml, P=0.005]. Both group showed successive
decrease of qHBsAg and then “precipitous HBsAg decline”
prior to HBsAg loss. SR group acheived HBsAg loss sooner
than the CR group (29 vs 54 months, P=0.016). The time from
EOT to the start of “precipitous HBsAg decline” was similar
in both groups, the HBsAg level at the start of “precipitous
HBsAg decline” was much lower in SR group (42.3 (0.6-766)
vs. 326 (26.5-1920) IU/ml, P=0.0068) while the decline slope
in SR group was only slightly greater (-1.29 log10IU/ml per
year vs. -1.01 log10IU/ml per year, P=0.7146). The time from
that point of start to HBsAg loss was shorter in SR group (23.8
vs. 39.5 months, P=0.012). Of the 11 patients in CR group, 9
showed “precipitous HBsAg decline” prior to clinical relapse
and the remaining 2 and one of the 9 patients showed superprecipitous
decline (> 1 log10 decline/year) following clinical
relapse. Conclusion: Both SR and CR groups patients
showed similar HBsAg kinetic of successive decline followed
by a “precipitous HBsAg decline” prior to HBsAg loss. The
lower EOT qHBsAg in SR group may be indicative of better
immune control and hence followed by sooner and uneventful
HBsAg loss.
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