停用核苷（酸）類似物治療慢性乙型肝炎：一種選擇

StephenW

停用核苷（酸）類似物治療慢性乙型肝炎：一種選擇

斯坦尼斯拉斯波爾 1
    1
    巴黎大學； Département d'Hépatologie/Addictologie, Hôpital Cochin, APHP;法國巴黎。電子地址：[email protected]。

    PMID：34914942 DOI：10.1053/j.gastro.2021.12.240

“ Hirode 等人的多中心國際 RETRACT-B 隊列研究，首次使用可用臨床數據分析結果，對慢性乙型肝炎患者 NUC 停用的多種族研究，包括 1552 名 HBe 抗原陰性慢性感染患者停止
現行做法下的 NUC[16]。 HBsAg 消失的累積概率（主要結果）在 12 個月和 48 個月的隨訪中分別為 3.2% 和 13.0%，是未停用 NUC 的通常報告的 10 倍[17]，但低於其他
研究[10-14]。 HBsAg 消失在白種人中比亞洲人高 6.8 倍，並且在治療結束時 HBsAg 滴度低（白種人 < 1000 IU/mL 或 <
亞洲人為 100 IU/mL）。治療結束 48 個月時，HBsAg 消失率 < 100 IU/mL 的患者為 43%，而滴度在 100 之間的患者為 7.4%。
和 1000 IU/mL，滴度大於 1000 IU/mL 的為 1.1%。 50 歲以上患者的 HBsAg 消失率更高（白種人為 16.8% 對 8.7%，白種人為 36.5% 對 10.6%
亞洲人）和接受替諾福韋治療的患者與恩替卡韋相比（18.1% vs 10.5%，但與恩替卡韋治療的患者相比，接受替諾福韋治療的患者經歷更早且複發率更高）。長期 NUC 治療和以前的干擾素治療也與 HBsAg 消失有關，但與肝硬化無關。因此，停用 NUC 的最佳人選是 HBeAg 陰性、HBsAg 滴度低的非肝硬化患者。然而，作者建議密切監測以防止惡化。該研究證實病毒學復發率高 [10-14,18] 從 6 個月時的 47.8%、12 個月時的 68.9% 增加到 48 個月時的 83.4%，導致 NUC 再治療的比例分別為 16.2%、29.8%分別為 54.7%。年齡、治療開始時的 HBe 狀態和 HBsAg 滴度是與再治療風險顯著相關的因素，比以前報導的要高，以及與肝功能失代償或 HCC 相關[10-14]。

StephenW

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].

StephenW

https://www.gastrojournal.org/article/S0016-5085(21)04075-0/pdf