AASLD2019[457]在3年的随访期间，HBsAg丢失率仍然很低 HBeAg阴性的

StephenW

457
HBsAg loss rates remain low during 3-year follow-up of
HBeAg negative patients with chronic hepatitis B after
nucleos(t)ide analogue withdrawal: results of the Toronto
STOP Study
Kin Seng Liem1,2, Bahareh Moazen1, Scott K Fung1,3,
David KH Wong1, Jiayun Chen1, Colina K. Yim1, Seham
Noureldin1, Jordan J. Feld4,5, Bettina E. Hansen1,6 and Harry
L. A. Janssen1, (1)Toronto Centre for Liver Disease, Toronto
General Hospital, University Health Network, (2)Department
of Gastroenterology & Hepatology, Erasmus Medical Centre
Rotterdam, (3)University of Toronto, Toronto, on, Canada,
(4)Mclaughlin-Rotman Centre for Global Health, (5)Toronto
Centre for Liver Disease, University Health Network, (6)
Institute of Health Policy, Management and Evaluation,
University of Toronto
Background: Several studies have investigated the potential
of nucleos(t)ide analogues (NA) withdrawal in patients
with chronic hepatitis B (CHB), but have lacked long-term
follow-up (LTFU). We prospectively evaluated the long-term
outcomes during NA discontinuation in HBeAg negative
patients Methods: Patients who stopped or continued NA
therapy for 72 weeks in a single-center trial were eligible to
participate in this LTFU study Patients were retreated in case
of persistent HBV DNA>20,000IU/mL, HBeAg seroreversion
or HBV DNA>2,000 with ALT>5xULN. These criteria allowed
viral relapse, but not at the cost of severe and dangerous
flares. Retreatment, HBsAg loss and HBsAg decline were
evaluated Results: Out of 66 included patients (60% male,
97% Asian), 45 patients stopped and 21 continued NA therapy
The median (IQR) duration of follow-up was 132 (52) weeks,
and 17/45 (38%) stop patients received retreatment initially
At the end of LTFU, 23/45 (51%) stop patients received
retreatment, of which 6/45 (13%) had a sustained off-therapy
response until week 72 The probability of retreatment
increased linearly beyond week 12 (see Figure) Five of
the 22 (23%) patients randomized to treatment continuation
elected to stop therapy after week 72 and 2 (40%) of them
remained off therapy thus far Beyond week 72, no HBsAg
loss occurred Mean (SD) HBsAg decline from randomization
to LTFU was 0 4 (0 4) log IU/mL and did not differ according
to randomization or retreatment (p>0.05). HBsAg decline >1
log IU/mL was achieved in 4/23 (17%) retreated stop patients,
4/22 (18%) not retreated stop patients, and 1/21 (5%) continue
patient Eleven (17%) patients reached HBsAg <100 IU/mL
HBeAg seroreversion occurred in 9/45 (20%) stop patients
Although two stop patients developed a severe ALT flare
(864-1,610 IU/mL) with concurrent bilirubin increase (114-
68 umol/L), no patient experienced liver decompensation or
died Conclusion: During 3-year observation of an Asian
majority NA stop cohort, no further HBsAg loss occurred
beyond week 72 while the rate of HBsAg decline remained
low. These findings suggest that even during longer follow-up
and with liberal retreatment criteria, stop patients are at risk
of significant relapse and retreatment, although the odds of
achieving functional cure remain limited.

StephenW

457
在3年的随访期间，HBsAg丢失率仍然很低
HBeAg阴性的慢性乙型肝炎患者术后
核苷酸（t）ide类似物的退出：多伦多的结果
停止学习
Kin Seng Liem1,2，Bahareh Moazen1，Scott K Fung1,3，
黄大卫（David KH Wong）1，陈嘉韵1（Chen）K. Yim1（Seham）
Noureldin1，Jordan J.Feld4,5，Bettina E.Hansen1,6和Harry
L.A.Janssen1，（1）多伦多多伦多肝病中心
大学卫生网综合医院（2）
伊拉斯姆斯医学中心胃肠病学和肝病学
鹿特丹（3）多伦多大学，多伦多，加拿大，
（4）麦克劳林-罗特曼全球卫生中心，（5）多伦多
大学卫生网络肝病中心，（6）
卫生政策，管理与评估研究所，
多伦多大学
背景：几项研究调查了潜在的
患者核苷酸（t）类似物（NA）的撤离
患有慢性乙型肝炎（CHB），但长期缺乏
后续行动（LTFU）。我们对长期评估
HBeAg阴性的NA停用期间的预后
患者方法：停药或持续NA的患者
在一项单中心试验中治疗72周符合资格
参加该LTFU研究
持久性HBV DNA> 20,000IU / mL，HBeAg血清逆转
或HBV DNA> 2,000，而ALT> 5xULN。这些条件允许
病毒复发，但不以严重和危险为代价
耀斑。复治，HBsAg丢失和HBsAg下降
评价结果：66名患者中（60％为男性，
97％的亚洲人），45名患者停药和21例继续进行NA治疗
随访的中位数（IQR）时间为132（52）周，
和17/45（38％）停止接受治疗的患者最初接受了再治疗
在LTFU结束时，接受了23/45（51％）停止治疗的患者
再治疗，其中6/45（13％）接受了持续的非治疗
直到第72周为止的反应
在第12周之后线性增加（见图）
22名（23％）患者被随机分配继续治疗
选择在72周和2周（40％）之后停止治疗
迄今仍未接受任何治疗72周后，仍无HBsAg
发生丢失随机分组的平均（SD）HBsAg下降
LTFU的浓度为0 4（0 4）log IU / mL，根据
随机或复治（p> 0.05）。 HBsAg下降> 1
在停止治疗的4/23（17％）患者中达到log IU / mL，
4/22（18％）未停药的患者停止治疗，而1/21（5％）继续治疗
患者11名（17％）患者达到HBsAg <100 IU / mL
9/45（20％）停止患者发生HBeAg血清逆转
尽管两个停药患者出现严重的ALT发作
（864-1,610 IU / mL）并发胆红素升高（114-
68 umol / L），没有患者出现肝失代偿或
死亡结论：在对亚洲人的3年观察中
多数NA停止人群，未再发生HBsAg损失
72周后，HBsAg下降率仍保持
低。这些发现表明，即使在更长的随访期间
并采用宽松的再治疗标准，阻止患者处于危险之中
尽管复发的几率很高
实现功能固化仍然有限。