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Withdrawal of nucleos(t)ide analogues in the treatment of chronic hepatitis B: a cornelian choice
Stanislas Pol 1
1
Université de Paris; Département d'Hépatologie/Addictologie, Hôpital Cochin, APHP; Paris, France. Electronic address: [email protected].
PMID: 34914942 DOI: 10.1053/j.gastro.2021.12.240
"The multi-center international RETRACT-B cohort study by Hirode et al., first multi-ethnic study of NUC withdrawal in chronic hepatitis B using avaliable clinical data to analyze outcomes, included 1552 patients with HBe antigen negative chronic infection who stopped
NUC under the current practice[16]. The cumulative probability of HBsAg loss, primary outcome, was 3.2% at 12 months and 13.0% at forty-eight months of follow-up, ten-fold higher than usually reported without NUC discontinuation[17], but lower than in other
studies[10-14]. HBsAg loss was 6.8-fold more common in Caucasians than in Asians and high in patients with a low HBsAg titer at the end of treatment (< 1000 IU/mL for Caucasians or <
100 IU/mL for Asians). HBsAg loss at forty-eight months post treatment was 43% for those with < 100 IU/mL at the end of treatment versus 7.4% for those with a titer between 100
and 1000 IU/mL and 1.1% for those with a titer greater than 1000 IU/mL. HBsAg loss was higher in patients over 50 years (16.8 versus 8.7% in Caucasians and 36.5 versus 10.6% in
Asians) and in patients treated with tenofovir compared to entecavir (18.1 versus 10.5% but Tenofovir-treated patients experienced earlier and higher rates of relapse compared to entecavir-treated patients). Long-term NUC therapy and previous Interferon therapy were also associated with HBsAg loss but not cirrhosis. Thus, the best candidates for NUC withdrawal are HBeAg negative non-cirrhotic patients with low HBsAg titers. However, authors recommend close monitoring to prevent deterioration. This study confirms the high rate of virological relapse[10-14,18] increasing from 47.8% at 6 months, 68.9% at 12 months to 83.4% at 48 months, resulting in NUC re-treatment in 16.2%, 29.8 % then to 54.7% in the same timelines, respectively. Age, HBe status at the start of treatment and HBsAg titer were factors significantly linked to the risk of retreatment with higher rate than previously reported as well as regarding hepatic decompensation or HCC[10-14]. |
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