AASLD2020[783]核苷类似物的有益作用 HBEAG阴性患者的治疗中断

StephenW

783
BENEFICIAL EFFECT OF NUCLEOS(T)IDE ANALOGUE
TREATMENT INTERRUPTION IN HBEAG NEGATIVE PATIENTS
WITH CHRONIC HEPATITIS B: 3 YEAR FOLLOW UP OF THE
TORONTO STOP STUDY
Arif Sarowar1, Kin Seng Liem1, Scott K. Fung1, David Kh
Wong1, Jordan J. Feld1,2, Seham Noureldin1, Colina K. Yim1,
Jiayun Chen1, Bettina E. Hansen1,3 and Harry L.A. Janssen1,
(1)Toronto Centre for Liver Disease, University Health
Network, (2)Mclaughlin-Rotman Centre for Global Health, (3)
Institute of Health Policy, Management and Evaluation
Background: Studies have investigated the benefits of
nucleos(t)ide analogues (NA) discontinuation in chronic
hepatitis B (CHB) patients, however long-term follow-up
(LTFU) and outcomes of those eventually retreated remain
limited We prospectively evaluated long term outcomes
in HBeAg negative patients during NA discontinuation and
retreatment Methods: Patients who stopped or continued
NA therapy for 72 weeks in a single-center randomized
controlled prospective trial were evaluated in this LTFU study
Patients were retreated according to a standardized protocol
if they had HBV DNA >20,000IU/mL, HBeAg seroreversion,
or HBV DNA>2000IU/mL with ALT>5xULN. HBsAg loss and
HBsAg decline were compared Results: Out of 66 patients
eligible in this study, 45 patients stopped and 21 continued NA
therapy at time of randomization Mean duration of LTFU was
172 weeks 23/45 stop patients required retreatment, with
median time to retreatment being 23 1 weeks HBsAg loss
was achieved by 2/45 (4%) patients randomized to stop and
1/21 (5%) continue patient at LTFU. HBsAg decline >1 log10
IU/mL at LTFU was achieved by 3/22 (14%) not-retreated stop
patients, 1/23 (4%) retreated stop patients, and 1/21 (5%)
continue treatment patients. HBsAg decline > 0.5 log10 IU/mL
at LTFU was achieved by 9/22 (41%) not-retreated patients,
7/23 (30%) retreated stop patient, and 3/21 (14%) continue
patients During LTFU, stop patients that were retreated
experienced no significant HBsAg decline before retreatment
(-0 02 [-0 13 – 0 08] log10 IU/mL/year, P=0 66), but yielded
significant declines after retreatment (-0.10 [-0.16 – -0.03] log10
IU/mL/year, P<0 01) Stop patients not-retreated experienced
significant HBsAg declines (-0.14 [-0.20 – -0.09] log10 IU/
mL/year P<0 01) while continue patients experienced no
significant declines with (-0.07 [-0.14 – 0.00] log10 IU/mL/year,
P=0 07) No patients experienced adverse outcomes, liver
decompensation, or death Conclusion: CHB patients that
stop NA and are retreated have limited HBsAg declines before
retreatment but higher HBsAg declines after retreatment CHB
patients after NA discontinuation, regardless of retreatment,
show higher rates of HBsAg declines at LTFU compared to
those that continued treatment, showing benefits not only for
discontinuation but also for interruption of NA therapy.

StephenW

783
核苷类似物的有益作用
HBEAG阴性患者的治疗中断
慢性乙型肝炎：随访3年
多伦多停止学习
Arif Sarowar1，Kin Seng Liem1，Scott K.Fung1，David Kh
Wong1，Jordan J. Feld1,2，Seham Noureldin1，Colina K. Yim1，
Chenjiayun1，Bettina E.Hansen1,3和Harry L.A.Janssen1，
（1）多伦多大学肝脏疾病研究中心
网络（2）麦克劳林-罗特曼全球卫生中心（3）
卫生政策，管理与评估研究所
背景：研究已经调查了
慢性核苷酸（t）ide类似物（NA）停产
乙型肝炎（CHB）患者，但需要长期随访
（LTFU）和最终退缩者的结局仍然存在
有限我们对长期结果进行了前瞻性评估
在NA停用期间HBeAg阴性患者中
再治疗方法：停止或继续的患者
在单中心随机分配中进行72周的NA治疗
这项LTFU研究评估了对照的前瞻性试验
根据标准化方案对患者进行了治疗
如果他们的HBV DNA> 20,000IU / mL，HBeAg血清逆转，
或HBV DNA> 2000IU / mL，ALT> 5xULN。 HBsAg丢失和
比较了HBsAg下降的结果：66名患者中
符合这项研究条件的患者中，有45名患者停药，而21名继续
随机分配治疗时间LTFU的平均持续时间为
172周23/45停药的患者需要重新治疗，
中位再治疗时间为23 1周HBsAg丢失
2/45（4％）患者被随机分配停药并达到
1/21（5％）继续在LTFU住院。 HBsAg下降> 1 log10
LTFU的IU / mL达到了3/22（14％）的未复归停止剂量
患者，1/23（4％）停止治疗的患者和1/21（5％）
继续治疗患者。 HBsAg下降> 0.5 log10 IU / mL
未经治疗的9/22（41％）患者达到了LTFU的治疗水平，
7/23（30％）的患者停止治疗，而3/21（14％）的患者继续
患者在LTFU期间，停止接受复治的患者
复治前HBsAg无明显下降
（-0 02 [-0 13 – 0 08] log10 IU / mL /年，P = 0 66），但产生了
再治疗后显着下降（-0.10 [-0.16 – -0.03] log10
IU / mL /年，P <0 01）停止未治疗的患者
HBsAg显着下降（-0.14 [-0.20 – -0.09] log10 IU /
毫升/年P <0 01）持续患者无
（-0.07 [-0.14 – 0.00] log10 IU / mL /年，
P = 0 07）没有患者出现不良后果，肝脏
代偿失调或死亡结论：CHB患者认为
停止NA并被退回之前，HBsAg的下降有限
复治，但乙肝治疗后HBsAg下降较高
NA停用后的患者，无论是否接受再次治疗，
与相比，LTFU的HBsAg下降率更高
那些继续治疗的人，不仅显示出对
停药，也可中断NA治疗。