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Liver Int. 2019 Dec 16. doi: 10.1111/liv.14330. [Epub ahead of print]
The safety of stopping nucleos(t)ide analogue treatment in patients with HBeAg-negative chronic hepatitis B.
Wong GL1,2,3, Chan HL1,2,3, Yuen BW1, Tse YK1,2, Luk HW2, Yip TC1,2, Hui VW4, Liang LY1,2, Lee HW5, Lui GC2, Wong VW1,2,3.
Author information
1
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
2
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
3
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
4
Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China.
5
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Abstract
BACKGROUND:
The rates of hepatitis B surface antigen (HBsAg) seroclearance after stopping nucleos(t)ide analogues (NA) in European (19% in 2 years) and Asian (13% in 6 years) patients with chronic hepatitis B (CHB) vary dramatically. We evaluated the incidence of hepatitis flare and HBsAg seroclearance in hepatitis B e antigen (HBeAg)-negative Chinese CHB patients who had stopped NA.
METHODS:
This was a territory-wide retrospective study in Hong Kong. We identified HBeAg-negative CHB patients from January 2000 to December 2017 who had stopped NA treatment for more than 3 months. Hepatitis flare was defined as ALT >2xULN.
RESULTS:
The 1,076 patients were predominantly middle-aged men (mean age 52 years, male 74.8%) when starting NA; they stopped NA after 82±35 months of treatment. At 44.3 ± 24.6 months after stopping NA, 147 (13.6%) patients had hepatitis flare, which led to resumption of NA; whereas 77 (7.2%) patients had flare but did not resume NA. Decompensation occurred in 7/914 (0.8%) patients. 695 (64.6%) patients remained on NA treatment at the last visit. Eleven patients had achieved HBsAg seroclearance (six of them had hepatitis flare and one of these six patients achieved HBsAg seroclearance after NA was restarted). Hepatic events developed in 75/695 (10.8%) patients who had NA resumed versus 43/381 (11.3%) patients who did not resume NA (p=0.677) CONCLUSIONS: Hepatitis flare and retreatment were common in HBeAg-negative CHB patients who stopped NA treatment; whereas HBsAg seroclearance rarely occurred. Stopping NA to achieve functional cure should not be recommended at this moment.
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PMID:
31845462
DOI:
10.1111/liv.14330
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