非肝硬化HBeAg阳性慢性乙型肝炎停用和口服口服抗病毒药治疗

StephenW

Hepatitis B surface antigen kinetics after discontinuation of and retreatment with oral antivirals in non-cirrhotic HBeAg-positive chronic hepatitis B
Hongjie Chen  1 , Xia Ding  1 , Guichan Liao  1 , Muye Xia  1 , Zuning Ren  1 , Rong Fan  1 , Jie Peng  1
Affiliations
Affiliation

    1
    Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangzhou, China.

    PMID: 33899998 DOI: 10.1111/jvh.13526

Abstract

The outcome of nucleos(t)ide analogues (NAs) discontinuation and retreatment is still uncertain. We evaluated hepatitis B surface antigen (HBsAg) kinetics after NAs discontinuation and during retreatment due to off-treatment clinical relapse among non-cirrhotic HBeAg-positive CHB patients. Four groups were studied: 129 HBeAg-positive patients from a prospective cohort who stopped NAs therapy after achieving sustained response (Group A), 39 patients who received retreatment after off-treatment clinical relapse in the discontinuation group (Group B), 214 patients who maintained treatment after achieving sustained response (Group C), and 291 patients who firstly initiated antiviral treatment (group D). During a 5-year follow-up, the cumulative incidence of HBsAg loss was significantly higher in Group A than Group C (22.3% vs. 1.6%, P <0.001). The quantitative HBsAg (qHBsAg) level at enrolment and NAs discontinuation were independently associated with HBsAg loss. Additionally, patients in Group B showed significantly greater HBsAg loss than those in the groups C and D, with 5-year cumulative incidences of 9.0%, 1.6% (P =0.040) and 0% (P <0.001), respectively. Moreover, patients in the Group B exhibited better virologic response (100% vs. 98.8%, P <0.001) and HBeAg seroconversion (92.6% vs. 69.8%, P <0.001) than those in Group D at year 5. Propensity score-matched analysis also showed the similar trend of HBsAg decline.NAs discontinuation with or without subsequent retreatment resulted in a more profound reduction of HBsAg in non-cirrhotic HBeAg-positive patients, suggesting that discontinuation may be a potential cure strategy for those with sustained virological suppression.

Keywords: discontinuation; hepatitis B surface antigen; nucleos(t)ide analogues; retreatment.

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StephenW

非肝硬化HBeAg阳性慢性乙型肝炎停用和口服口服抗病毒药治疗后的乙型肝炎表面抗原动力学
陈洪杰1，夏鼎1，廖蝉蝉1，夏牧业1，祖宁人1，荣帆1，揭鹏1
隶属关系
联系

    1个
    南方医科大学南方医院传染病科，器官衰竭研究国家重点实验室，广东省病毒性肝炎研究重点实验室，广州。

    PMID：33899998 DOI：10.1111 / jvh.13526

抽象的

核苷酸（t）ide类似物（NAs）停用和再治疗的结果仍不确定。我们评估了非肝硬化HBeAg阳性CHB患者在NAs停用后和因非治疗临床复发而在再治疗期间的乙肝表面抗原（HBsAg）动力学。研究了四组：来自前瞻性队列的129名HBeAg阳性患者，在获得持续缓解后停止了NAs​​治疗（A组），中断治疗组（B组）中有39例在非治疗临床复发后接受了复治，有214例患者在达到持续缓解后继续治疗（C组），以及首先开始抗病毒治疗的291例患者（D组）。在5年的随访中，A组的HBsAg丢失累积发生率显着高于C组（22.3％对1.6％，P <0.001）。入组时的定量HBsAg（qHBsAg）水平和NAs停药与HBsAg丢失独立相关。此外，B组患者的HBsAg损失明显高于C组和D组，其5年累积发生率分别为9.0％，1.6％（P = 0.040）和0％（P <0.001）。此外，B组患者在第5年时的病毒学应答（100％vs. 98.8％，P <0.001）和HBeAg血清转化（92.6％vs. 69.8％，P <0.001）优于D组。匹配分析还显示了类似的HBsAg下降趋势.NAs停用或不进行后续再治疗导致非肝硬化性HBeAg阳性患者的HBsAg降低更为显着，这表明停用可能是持续病毒学抑制的潜在治疗策略。

关键字：停产；乙型肝炎表面抗原；核苷（核苷酸）类似物;再治疗。

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StephenW

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jvh.13526