在乙型肝炎e抗原陰性患者中撤出核苷類似物：亞洲的觀點

StephenW

Withdrawal of Nucleos(t)ide Analogues in Hepatitis B e Antigen-Negative Patients: An Asian Perspective
Tung-Hung Su  1   2   3 , Jia-Horng Kao  1   2   3   4   5
Affiliations
Affiliations

    1
    Division of Gastroenterology and Hepatology Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan.
    2
    Department of Internal Medicine National Taiwan University College of Medicine Taipei Taiwan.
    3
    Hepatitis Research Center National Taiwan University Hospital Taipei Taiwan.
    4
    Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan.
    5
    Department of Medical Research National Taiwan University Hospital Taipei Taiwan.

    PMID: 33489096 PMCID: PMC7805293 DOI: 10.1002/cld.950
Chronic hepatitis B virus (HBV) infection is currently incur-able. Long-term treatment with potent and safe nucleos(t)ide analogues  (NAs)  can  reduce hepatocellular carcinoma  (HCC),  cirrhotic complications,  and liver-related mortality through substantial viral suppression.1 However, long-term therapy  raises several  crucial  issues  with  pros  and  cons.  Because hepatitis B surface antigen (HBsAg) seroclearance or functional cure is not easily achievable, a finite therapy may provide an opportunity to facilitate HBsAg seroclearance by the  rejuvenation  of  exhausted  immune  cells.  However,  the  virological relapse (VR) or surge of alanine aminotransferase (ALT) levels may increase the risk for adverse outcomes (e.g., decompensation, fibrosis progression, HCC, or liver-related mortality) before HBsAg seroclearance, which are the safety concerns  of  finite  therapy.  Little  is  known about  whether repeated therapeutic interruption will increase the chance of drug resistance, whereas the reduction of renal function and bone mineral density are the safety issues of infinite therapy. Lastly,  the  practice  of  “to  stop”  or  “to  continue”  therapy  should also consider the accessibility and affordability of thehealth  care  system.  Patients  who  stop  therapy  need  to  be  monitored  closely  with  frequent  virological  and  biochemical tests in the first year, especially if they experience a VR or clinical  (biochemical)  relapse  (CR)  (Table  1).  About  40%  of patients who stop NA therapy eventually receive retreatment.2 The cost-effective analysis should thus be performed on the basis of individual regions.

StephenW

在乙型肝炎e抗原阴性患者中撤出核苷类似物：亚洲的观点苏东雄1 2 3，高嘉鸿1 2 3 4 5隶属关系隶属关系    1个    国立台湾大学附属医院消化内科肝内科，台湾台北。    2    国立台湾大学医学院内科学系台湾台北。    3    国立台湾大学附属医院肝炎研究中心，台湾台北。    4    国立台湾大学医学院临床医学研究所，台湾台北。    5    国立台湾大学医院医学研究室，台湾台北。    PMID：33489096 PMCID：PMC7805293 DOI：10.1002 / cld.950目前无法治愈慢性乙型肝炎病毒（HBV）。通过有效的病毒抑制作用，长期有效和安全的核苷酸类似物（NAs）长期治疗可降低肝细胞癌（HCC），肝硬化并发症和与肝有关的死亡率。1然而，长期治疗引起了一些关键问题利弊。由于不容易实现乙肝表面抗原（HBsAg）血清清除或功能性治愈，因此有限的疗法可能会通过使疲惫的免疫细胞恢复活力来提供促进HBsAg血清清除的机会。但是，HBsAg血清清除之前的病毒学复发（VR）或丙氨酸氨基转移酶（ALT）水平升高可能会增加不良后果（例如代偿失调，纤维化进展，HCC或肝相关死亡率）的风险，这是安全性问题有限疗法。关于反复治疗中断是否会增加耐药性的知之甚少，而肾功能和骨矿物质密度的降低是无限治疗的安全性问题。最后，“停止”或“继续”治疗的做法还应考虑卫生保健系统的可及性和可负担性。停止治疗的患者在第一年需要经常进行病毒学和生化测试，尤其是如果他们经历VR或临床（生化）复发（CR）时，应密切监测其病情（表1）。停止NA治疗的患者中约有40％最终会退缩。2因此，应根据各个地区进行具有成本效益的分析。

StephenW

https://aasldpubs.onlinelibrary. ... ect/10.1002/cld.950