核苷（酸）类似物停止治疗对慢性乙型肝炎患者的影响：系

StephenW

核苷（酸）类似物停止治疗对慢性乙型肝炎患者的影响：系统评价和荟萃分析
棉王1、明霞千2、富荣融3、张益琴4、沉新兰5、邓元悦2、宁王2、雷洋4
隶属关系
隶属关系

    1
    宁波市鄞州第二医院感染科。
    2
    浙江中医药大学公共卫生学院，杭州，中国。
    3
    浙江中医药大学第一临床医学院，中国杭州。
    4
    宁波市鄞州第二医院急诊医学中心。
    5
    浙江中医药大学第二临床医学院，杭州，中国。

    PMID：34568257 PMCID：PMC8460900 DOI：10.3389/fpubh.2021.709220

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背景和目的：虽然大多数慢性乙型肝炎（CHB）患者在接受长期核苷（酸）类似物（Nucs）治疗后实现了有效的病毒学抑制，但在监测下停止治疗的安全性仍存在争议。方法：我们通过在 1990 年 1 月至 2021 年 2 月搜索 PubMed、Embase、Cochrane Library 和 Web of Science 来确定研究。符合条件的研究比较了 CHB 患者中停止和继续使用 Nucs 治疗组之间的长期结果。本研究旨在调查 CHB 患者中停止和维持 Nucs 治疗组之间的长期结果，包括生化、血清学和病毒学结果，以及肝细胞癌 (HCC) 发展率。结果：五项符合条件的研究被选中进行荟萃分析，涵盖 1,425 名患者。我们的结果表明，与在监测下继续使用 Nucs 治疗的患者相比，停用 Nucs 治疗的患者出现丙氨酸转氨酶 (ALT) 发作的风险更高（OR = 9.39，95%CI = 3.87-22.78）。与继续使用 Nucs 治疗的患者相比，Nucs 停药患者具有更高的病毒学结合发生率 (OR = 617.96, 95%CI = 112.48-3,395.14) 和更高的 HBV DNA 水平 (OR = 9.39, 95%CI = 3.87-22.78)。两组间高胆红素血症、肝功能失代偿和 HCC 发展的风险无统计学显着差异。 Nucs 停药组患者的 HBsAg 消失率高于继续治疗组（OR = 7.10，95%CI = 6.68-13.69）。结论：与继续使用 Nucs 治疗的患者相比，Nucs 停药患者可能表现出更高的 HBsAg 消失机会。需要在 Nucs 停止治疗后密切监测，并在 ALT 浓度升高时及时重新启动 Nucs 治疗。

关键词：慢性乙型肝炎；保持;荟萃分析；核苷（酸）类似物；停止治疗。

版权所有 © 2021 Wang, Qian, Fu, Zhang, Shen, Yao, Wang and Yang。

StephenW

The Impact of Nucleos(t)ide Analogs Off-Therapy Among Chronic Hepatitis B Patients: A Systematic Review and Meta-Analysis
Mian Wang  1 , Mingxia Qian  2 , Rongrong Fu  3 , Yiqin Zhang  4 , Xinlan Shen  5 , Dengyuan Yue  2 , Ning Wang  2 , Lei Yang  4
Affiliations
Affiliations

    1
    Infection Department, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.
    2
    School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
    3
    The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
    4
    Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.
    5
    The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.

    PMID: 34568257 PMCID: PMC8460900 DOI: 10.3389/fpubh.2021.709220

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Abstract

Background and Aim: Although most chronic hepatitis B (CHB) patients achieve effective virological suppression after receiving long-term nucleos(t)ide analogs (Nucs) therapy, the safety of off-therapy is controversial under the monitor. Methods: We identified studies through searching PubMed, Embase, Cochrane Library, and Web of Science from January 1990 to February 2021. The eligible studies compare the long outcomes between discontinued and continued Nucs treatments groups among CHB patients. This study was conducted to investigate long-term outcomes, including biochemical, serological, and virological outcomes, as well as hepatocellular carcinoma (HCC) development rate between discontinued and maintained Nucs therapy groups among CHB patients. Results: Five eligible studies covering 1,425 patients were selected for meta-analysis. Our result exhibits that patients with Nucs off-treatment have a higher risk of alanine aminotransferase (ALT) flares-up than those who continued Nucs therapy under the monitor (OR = 9.39, 95%CI = 3.87-22.78). Nucs off-therapy patients have a higher virological bound incidence (OR = 617.96, 95%CI = 112.48-3,395.14) and a higher HBV DNA level (OR = 9.39, 95%CI = 3.87-22.78) than those who continued Nucs therapy. There was no statistically significant difference in the risk of hyperbilirubinaemia, hepatic decompensation, and HCC development between both two groups. Patients in Nucs off-therapy group demonstrate a higher HBsAg loss rate than those in the continued group (OR = 7.10, 95%CI = 6.68-13.69). Conclusions: Nucs off-therapy patients may exhibit a higher chance of achieving HBsAg loss than those who continue Nucs therapy. It requires close monitoring after Nucs off-therapy and timely restarting of Nucs therapy when ALT concentrations increase.

Keywords: chronic hepatitis B; maintained; meta-analysis; nucleos(t)ide analogs; off-treatment.

Copyright © 2021 Wang, Qian, Fu, Zhang, Shen, Yue, Wang and Yang.

StephenW

https://pubmed.ncbi.nlm.nih.gov/34568257/