有效抗病毒治疗后HBsAg丢失，复发和再治疗的预测因素

StephenW

Predictors of HBsAg Loss, Relapse, and Retreatment After Effective Antiviral Therapy
Virginia A. Schad, PharmD, RPh
Monitoring serum levels of hepatitis B surface antigen (HBsAg), interferon inducible protein-10 (IP10), and hepatitis B core-related antigen (HBcrAg) may be useful for the management of patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) who discontinue long-term nucleos(t)ide analogue (NA) therapy, according to a study published in the Journal of Viral Hepatitis.

HBsAg loss is the therapeutic goal for patients with CHB, but it rarely occurs during treatment. Thus, discontinuation of NAs before HBsAg loss may be considered in patients who have achieved virological remission. Unfortunately, reliable predictors of outcomes after treatment discontinuation in patients whose serum levels are HBeAg-negative CHB have not been established; therefore, researchers investigated the role of HBsAg, IP10, and HBcrAg serum levels as predictors of HBsAg loss, relapse, and retreatment in those who discontinue long-term antiviral therapy.
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Fifty-seven patients who had HBsAg-positive serum levels were followed monthly for 3 months, every 2/3 months until month 12, and every 3/6 months thereafter. The researchers found that noncirrhotic patients with HBeAg-negative CHB remaining in long-term on-therapy virological remission who achieve an HBsAg<100 IU/mL have a high probability of HBsAg loss and sustained post-NA remission, and can safely stop treatment. However, patients with an HBsAg>1000 IU/mL have less favorable outcomes after NA discontinuation, and therefore such a decision may not be justified. In patients with intermediate HBsAg levels of 100 to 1000 IU/mL, decisions may need to be individualized, depending on the desirable outcome, but IP10 levels at 1 month after discontinuation could be a useful predictor of subsequent HBsAg loss. In addition, HBcrAg at NA discontinuation may be useful in predicting post-NA outcome.

The authors concluded that, “Larger studies are needed to further evaluate and confirm these findings which may guide the management of HBeAg-negative CHB patients who discontinue NA therapy.”

Disclosure: This clinical trial was supported by Gilead Sciences. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Papatheodoridi M, Hadziyannis E, Berby F, et al. Predictors of HBsAg loss, relapse and retreatment after discontinuation of effective oral antiviral therapy in non-cirrhotic HBeAg-negative chronic hepatitis B [published online September 28, 2019]. J Viral Hepat. doi:10.1111/jvh.13211

StephenW

有效抗病毒治疗后HBsAg丢失，复发和再治疗的预测因素
弗吉尼亚·夏德（Virginia A.
监测血清乙型肝炎表面抗原（HBsAg），干扰素诱导型蛋白10（IP10）和乙型肝炎核心相关抗原（HBcrAg）的水平可能有助于管理乙型肝炎e抗原（HBeAg）阴性的慢性患者根据发表在《病毒性肝炎杂志》上的一项研究，中止长期核苷酸（t）类似物（NA）治疗的乙型肝炎（CHB）。

HBsAg丢失是CHB患者的治疗目标，但在治疗期间很少发生。因此，对于达到病毒学缓解的患者，可以考虑在HBsAg丢失之前停用NAs。不幸的是，对于血清水平为HBeAg阴性CHB的患者，中止治疗后结局的可靠预测指标尚未建立；因此，研究人员调查了中止长期抗病毒治疗者中HBsAg，IP10和HBcrAg血清水平作为HBsAg丢失，复发和再治疗的指标的作用。
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每月对57名HBsAg阳性血清水平的患者进行3个月的随访，每2/3个月随访一次，直到第12个月，此后每3/6个月随访一次。研究人员发现，HBsAg <100 IU / mL且长期接受治疗的病毒学缓解而仍保持HBeAg阴性CHB的非肝硬化患者，HBsAg丢失的可能性较高，NA缓解后持续存在，并且可以安全地停止治疗。但是，HBsAg> 1000 IU / mL的患者在NA停用后的预后较差，因此可能无法做出这样的决定。在中度HBsAg水平为100至1000 IU / mL的患者中，可能需要根据预期结果进行个体化决定，但停药后1个月的IP10水平可能是随后HBsAg丢失的有用预测指标。此外，NA终止时的HBcrAg可能有助于预测NA后的结果。

作者得出的结论是：“需要进行更大的研究来进一步评估和证实这些发现，这可能会指导中断NA治疗的HBeAg阴性CHB患者的治疗。”

披露：该临床试验得到了吉利德科学公司的支持。几位研究作者宣布与制药行业有从属关系。请参阅原始参考资料，以获得作者披露的完整列表。

参考

Papatheodoridi M，Hadziyannis E，Berby F等。非肝硬化HBeAg阴性慢性乙型肝炎停用有效的口服抗病毒治疗后，HBsAg丢失，复发和再治疗的预测因素[在线发布于2019年9月28日]。 J病毒性肝炎。 doi：10.1111 / jvh.13211