慢性乙型肝炎停用核苷酸（t）类似物治疗的当前实践和相反

StephenW

Current practice and contrasting views on discontinuation of nucleos(t)ide analog therapy in chronic hepatitis B
Emilia Hadziyannis & Stephanos Hadziyannis
Received 22 Dec 2019, Accepted 02 Mar 2020, Published online: 12 Mar 2020

    Download citation https://doi.org/10.1080/17474124.2020.1738219 CrossMark Logo CrossMark

ABSTRACT

Introduction: Long-term, even indefinite treatment with nucleos(t)ide analogs (NAs) is the current first-line therapy for patients with chronic hepatitis B (CHB), regardless of its histological stage. Guidelines and recommendations on duration and endpoints of NA therapy in CHB are not identical and change over time.

Areas covered: The authors review NA discontinuation approaches and views with an emphasis on HBeAg-negative patients based on published studies relevant to the topic, stressing on whether or not the optimal endpoint of HBsAg loss is practically achievable.

Expert opinion: Discontinuation of NA therapy in HBeAg-negative noncirrhotic patients has to be considered after long-term effective treatment with controlled liver disease activity, undetectable viremia, and significant decline in serum HBsAg titers. Close post-treatment monitoring is required for early intervention in cases of severe clinical relapse. Immediate retreatment hampers the favorable outcome of HBsAg clearance (functional cure) and should be avoided in transient ALT flares. Predictors of such relapses are still under investigation and include viral and patient factors. For HBeAg-positive noncirrhotic patients, there is wide acceptance of the endpoint of HBeAg seroconversion, after a long consolidation period.
KEYWORDS: Chronic Hepatitis B, nucleos(t)ide analog, treatment discontinuation, functional cure, HBV
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Funding
This manuscript was not funded.
Article Highlights

    Discontinuation of NA therapy in HBeAg-positive non-cirrhotic patients is considered in international practice guidelines after HBeAg seroconversion and consolidation treatment

    Discontinuation of NA therapy in HBeAg negative no cirrhotic patients is a safe option that is gaining increasing acceptance but views in certain aspects are still variable and evolving.

    Patients who discontinue treatment should be under close and long-term post-treatment follow-up.

    Relapses, attributed to restoration of HBV immunity, may be beneficial and should not be treated immediately except for severe or persisting cases

    Functional cure is achieved in higher rates in patients who discontinue treatment.

    End of treatment HBsAg level is currently the best predictor of outcome.

StephenW

慢性乙型肝炎停用核苷酸（t）类似物治疗的当前实践和相反观点
艾米莉亚·哈兹亚尼斯（Emilia Hadziyannis）和斯蒂芬诺斯·哈兹亚尼斯（Stephanos Hadziyannis）
2019年12月22日收到，2020年3月2日接受，在线发布：2020年3月12日

下载引文https://doi.org/10.1080/17474124.2020.1738219 CrossMark徽标CrossMark

抽象

简介：长期，甚至无限期的核苷酸类似物（NAs）治疗都是目前治疗慢性乙型肝炎（CHB）患者的一线治疗方法，无论其组织学阶段如何。关于CHB中NA治疗的持续时间和终点的指南和建议并不完全相同，并且会随着时间而变化。

涵盖的领域：作者根据与该主题相关的已发表研究回顾了NA停用方法和观点，重点是HBeAg阴性患者，并强调HBsAg损失的最佳终点是否切实可行。

专家意见：HBeAg阴性非肝硬化患者必须长期有效治疗，控制肝病活动，检测不到病毒血症，血清HBsAg滴度明显下降后，才应停止NA治疗。对于严重的临床复发病例，需要进行密切的治疗后监测以进行早期干预。立即再治疗会妨碍HBsAg清除的良好效果（功能性治愈），因此应避免在短暂性ALT发作时使用。这种复发的预测因素仍在研究中，包括病毒和患者因素。对于HBeAg阳性非肝硬化患者，经过长时间的巩固期后，HBeAg血清转化终点被广泛接受。
关键词：慢性乙型肝炎，核苷酸类似物，治疗中止，功能治愈，HBV
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该手稿未获得资助。
文章重点

HBeAg血清转化和巩固治疗后，国际实践指南中考虑了在HBeAg阳性非肝硬化患者中停用NA治疗

在HBeAg阴性的无肝硬化患者中停用NA治疗是一种安全的选择，正在逐渐获得接受，但在某些方面的观点仍在不断变化和发展。

中断治疗的患者应接受密切和长期的治疗后随访。

归因于HBV免疫力恢复的复发可能是有益的，除非严重或持续存在，否则不应立即治疗

停止治疗的患者可以更高的比率实现功能性治愈。

治疗结束时HBsAg水平目前是结果的最佳预测指标。