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645
KINETICS OF HEPATITIS B SURFACE ANTIGEN AND
INDICATIONS FOR RETREATMENT IN PATIENTS
ENCOUNTERING CLINICAL FLARE AFTER STOPPING
NUCLEOS(T)IDE ANALOGS
Yao-Chun Hsu1,2, Cheng-Hao Tseng3, Chi-Ming Tai4, Tzeng-
Huey Yang5, Chieh-Chang Chen6, Lien-Juei Mou7, Chi-Yang
Chang8, Ming-Shiang Wu6 and Jaw-Town Lin9, (1)I-Shou
University, (2) Gastroenterology and Hepatology, E-DA
Hospital, (3) Division of Gastroenterology and Hepatology,
Department of Internal Medicine, E-Da Cancer Hospital/IShou
University, (4) E-Da Hospital, (5) Lotung Poh-Ai Hospital,
(6) National Taiwan University Hospital, (7) Department of
Medicine, Tainan Municipal Hospital, (8)Fu-Jen Catholic
University Hospital, (9)Digestive Medicine Center, China
Medical University Hospital
Background: It remains controversial whether or when
Antiviral treatment should be resumed for the following
Cessation of nucleos(t)ide analogs (NAs) in patients with
Chronic hepatitis B (CHB) How kinetics of serum hepatitis B
Surface antigen (HBsAg) level may help to
Flares requiring retreatment has not been clarified.
This multicenter cohort study prospectively observed 184
CHB patients who discontinued NA therapy after being
Treated for a minimum of 3 years with negative hepatitis B e
Antigen (HBeAg) and undetectable viral DNA at NA cessation
Eligible patients were followed up for clinical flare, which
Was defined as serum alanine aminotransferase (ALT) rising
Above 80 U/L (i e , 2 folds the upper limit of normal according
To Asian-Pacific standard). Treatment was not indicated for
Clinical flare per se but was resumed for manifestations of
Hepatic decompensation, persistent flare lasting longer than
3 months, or cirrhosis. For patients encountering clinical flare,
The association between HBsAg kinetics and subsequent
Events indicating retreatment was explored Results: Between
July 2011 and October 2018, a total of 93 (50 5%) patients
(median age at NA cessation, 49 8 years; male, 82 8% or
n=77) developed clinical flare during a median follow-up
Of 27 2 (range, 3~82 8) months Among them, 55 (59%)
Patients resumed treatment for hepatic decompensation
(n=4) or persistent flare (n=51) with the retreatment rate of
70.1% (95% confidence interval, 58.5~80.8%) cumulatively
At 2 years following clinical flare. The serum HBsAg levels
At NA cessation were similar between retreated and
Untreated patients (mean ± standard error, 973 5 ± 175 7 vs
926 2 ± 214 2 IU/mL; P=0 86) However, patients requiring
Retreatment as compared with those who stacked untreated
Had significant higher HBsAg level at clinical flare (mean,
7240 0 ± 2038 6 vs 1995 8 ± 763 1 IU/mL; P=0 03) and also
Greater increase in HBsAg from NA cessation to clinical flare
(7089 6 ± 2373 0 vs 1316 4 ± 766 1 IU/mL; P=0 03) HBsAg
Level at clinical flare was associated with subsequent events
Indicating retreatment (hazard ratio, 1 69 per log IU/mL; 95%
CI, 1 21~2 35; P=0 002) Conclusion: In CHB patients who
Developed clinical flare after stopping NA therapy, those with
a higher HBsAg level measured at clinical flare or a greater
Increase in HBsAg from NA cessation were more likely to
Resume treatment for severe or persistent hepatitis Out data
Suggests HBsAg kinetics may help to distinguish "good or
Bad” flares following NA cessation in CHB patients. |
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发表于 2019-10-31 17:22
