AASLD2019[469]固结处理的最佳持续时间 停止HBEAG阴性NUC治疗之前

StephenW

469
THE OPTIMAL DURATION OF CONSOLIDATION TREATMENT
PRIOR TO CESSATION OF NUC THERAPY IN HBEAG-NEGATIVE
PATIENTS
Wen-Juei Jeng1,2, Yi-Cheng Chen2,3, I-Shyan Sheen1,4,
Rong-Nan Chien1,2 and Yun-Fan Liaw3,4, (1)College of
Medicine, Chang Gung University, Taiwan, (2)Department
of Gastroenterology and Hepatology, Chang Gung Memorial
Hospital, Linkou Branch, Taiwan, (3)College of Medicine,
Chang Gung University, (4)Department of Gastroenterology
and Hepatology, Chang Gung Memorial Hospital, Linkou
Branch
Background: In finite Nuc therapy in HBeAg negative
chronic hepatitis B (CHB) patients, the consolidation duration
proposed by APASL stopping rule is ≥ 1year. However, the
duration proposed in Western studies and EASL guidelines
was 2-3 years Aim: To investigate the optimal length of
consolidation treatment in terms of 1-year clinical relapse (CR:
HBV DNA ≥ 2000IU/ml + ALT ≥2X ULN) rate in a large number
of patients Methods: HBeAg negative CHB patients received
monotherapy with Nuc and stop therapy by APASL guidelines
(undetectable HBV DNA for more than 1 year) and had been
followed-up ≥ 1 year were recruited. The 1-year CR rate was
compared among patients with consolidation therapy of 1-2
year vs. 2-3 and ≥ 3 years. Baseline demographic features,
Nuc used, HBV DNA, qHBsAg level, treatment duration, ontreatment
early rapid qHBsAg decline, qHBsAg reduction > 1
log10IU/ml during treatment, time to ALT normalization, time to
undetectable DNA, consolidation treatment duration, end-oftreatment
(EOT) qHBsAg were compared between patients
with and without 1-year CR Logistic regression was applied to
investigate the predictors for 1-year clinical relapse Results:
A total of 902 patients were included, 719 were treated with
entecavir (ETV), 84.%% were males, mean age was 52.7
years, 42 7% were cirrhotics and 54 3% were treatment
experienced During 1-year follow-up, 72 4% patients
encountered virologic relapse and 44 6% CR Multivariate
analysis showed older age [aOR: 1.02 (1.01-1.04), P=0.0013],
cirrhotic [aOR: 1.35 (1.02-1.79), P=0.0375], ETV therapy
[ETV vs. non-ETV: aOR: 0.49 (0.35-0.68), P<0.0001], ALT
normalization > 6 months [aOR: 1.81 (1.28-2.55, P=0.0008)
and EOT qHBsAg level [aOR: 1.54 (1.21-1.95), P=0.0004]
were independent predictors for off-Nuc 1-year CR The
duration of consolidation therapy was not a factors for relapse
[1-2 year as referent, 2-3years: crude OR (95%CI): 1.01
(0.77-1.33) P=0.9478, ≥3 years: 0.96 (0.57-1.61) P=0.8716
respectively] (Figure) nor duration of total treatment [< 2
years as referent, 2-3, 3-4, ≥4: crude OR (95%CI): 0.98
(0 64-1 48), P=0 9075, 1 43 (0 94-2 18), P=0 0927, 0 8 (0 41-
1 55), P=0 5066, respectively] Conclusion: The results have
demonstrated that a consolidation duration > 1 year was not
inferior to those > 2 or > 3 years in terms of 1-year CR rate,
hence is more cost-effective in clinical practice.

StephenW

469
固结处理的最佳持续时间
停止HBEAG阴性NUC治疗之前
患者
曾文瑞1,2，陈以成2,3，左欣欣1,4，
钱荣南1,2，尹云帆3,4，（1）
台湾长庚大学医学系（2）
长庚纪念医院消化内科
台湾林口分院医院，（3）医学院
长庚大学（4）肠胃科
林口长庚纪念医院肝内科
科
背景：HBeAg阴性的有限Nuc治疗
慢性乙型肝炎（CHB）患者，巩固期
APASL提出的停止规则建议≥1年。但是，那
西方研究和EASL指南中建议的持续时间
是2-3年目的：调查最佳长度
根据1年的临床复发率进行巩固治疗（CR：
大量HBV DNA≥2000IU / ml + ALT≥2XULN）
方法：HBeAg阴性CHB患者接受
根据APASL指南进行Nuc单药治疗并停止治疗
（超过1年未检测到HBV DNA），并且已经
随访≥1年。 1年CR率为
1-2例巩固治疗患者之间的比较
年vs. 2-3和≥3年。基线人口统计特征，
使用的Nuc，HBV DNA，qHBsAg水平，治疗时间，治疗中
早期qHBsAg快速下降，qHBsAg减少> 1
治疗期间log10IU / ml，ALT正常化时间，
DNA检测不到，巩固治疗持续时间，治疗结束
比较患者之间的（EOT）qHBsAg
有和没有1年CR Logistic回归适用于
调查1年临床复发的预测因素结果：
共纳入902名患者，其中719名接受了
恩替卡韦（ETV），男性，占84。%%，平均年龄为52.7
年，肝硬化有42 7％，治疗有54 3％
在1年的随访中，有72位4％的患者
遇到病毒学复发和44 6％CR多变量
分析显示年龄较大[aOR：1.02（1.01-1.04），P = 0.0013]，
肝硬化[aOR：1.35（1.02-1.79），P = 0.0375]，ETV治疗
[ETV与非ETV：aOR：0.49（0.35-0.68），P <0.0001]，ALT
正常化> 6个月[aOR：1.81（1.28-2.55，P = 0.0008）
和EOT qHBsAg水平[aOR：1.54（1.21-1.95），P = 0.0004]
是非Nuc 1年CR的独立预测因子
巩固治疗的持续时间不是复发的因素
[1-2年作为参考，2-3年：原油或（95％CI）：1.01
（0.77-1.33）P = 0.9478，≥3年：0.96（0.57-1.61）P = 0.8716
分别]（图）或总治疗时间[<2
2-3年，3-4年，≥4年：粗制OR（95％CI）：0.98
（0 64-1 48），P = 0 9075、143（0 94-2 18），P = 0 0927、0 8（0 41-
1 55），P = 0 5066]结论：结果有
证明合并持续时间> 1年不是
在1年CR率方面，不及那些> 2年或> 3年的人，
因此在临床实践中更具成本效益。