在非肝硬化 HBeAg 阴性慢性乙型肝炎患者中停用核苷类似物：9

StephenW

在非肝硬化 HBeAg 阴性慢性乙型肝炎患者中停用核苷类似物：96 周时 HBsAg 消失与基线 HBsAg 水平低相关
Samuel A L Hall 1 2，Gareth S Burns 1 2，Despina Anagnostou 1，Sara Vogrin 2，Vijaya Sundararajan 2 3，Dilip Ratnam 4 5，Miriam T Levy 6，John S Lubel 7 8，Amanda J Nicoll 9，Simone I Strasser 10 11、威廉·西弗特 4 5、保罗 V 德斯蒙德 1、孟 C Ngu 12、彼得·安格斯 13 14、玛丽·辛克莱 13、克里斯托弗·梅雷迪思 15、盖尔·马修斯 16、彼得·雷维尔 17、凯西·杰克逊 17、玛格丽特·利特尔约翰 17、D 斯科特·鲍登17、斯蒂芬 A 洛迦尼尼 17、库马尔维斯瓦纳坦 1 2、亚历山大 J 汤普森 1 2
隶属关系
隶属关系

    1
    澳大利亚墨尔本圣文森特医院消化内科。
    2
    澳大利亚墨尔本圣文森特医院传染病和免疫学研究中心部。
    3
    澳大利亚墨尔本拉筹伯大学公共卫生系。
    4
    澳大利亚墨尔本莫纳什健康中心胃肠病学和肝病学部门。
    5
    澳大利亚墨尔本莫纳什大学。
    6
    澳大利亚悉尼利物浦医院消化内科。
    7
    澳大利亚墨尔本 Alfred Health 消化内科。
    8
    澳大利亚墨尔本阿尔弗雷德中心莫纳什大学中央临床学院。
    9
    澳大利亚墨尔本东部卫生局消化内科。
    10
    澳大利亚悉尼皇家阿尔弗雷德王子医院 AW Morrow 胃肠病学和肝脏中心。
    11
    悉尼大学，悉尼，澳大利亚。
    12
    澳大利亚悉尼康科德遣返总医院消化内科。
    13
    澳大利亚墨尔本 Austin Health 胃肠病学和肝病学系。
    14
    墨尔本大学，墨尔本，澳大利亚。
    15
    澳大利亚悉尼 Bankstown-Lidcombe 医院消化内科。
    16
    澳大利亚悉尼圣文森特医院传染病科。
    17
    澳大利亚墨尔本多尔蒂研究所皇家墨尔本医院维多利亚传染病参考实验室。

    PMID：35521992 DOI：10.1111/apt.16968

抽象的

背景和目的：目前的指南建议对 HBeAg 阴性慢性乙型肝炎 (CHB) 患者进行长期核苷类似物 (NA) 治疗。然而，在停止 NA 治疗以及 HBsAg 消失后，已经描述了疾病缓解。

方法：我们进行了一项停止 NA 治疗的前瞻性多中心队列研究。纳入标准为 HBeAg 阴性 CHB、无肝硬化和 HBVDNA<量化下限≥18 个月。我们评估了超过 96 周的病毒学和生化结果，包括 HBsAg 消失以及 NA 重新启动率。

结果：总共有 110 名患者 [62% 恩替卡韦 (ETV)； 28% 的替诺福韦 (TDF)，10% 的其他] 被纳入。中位年龄为 56 岁，57% 为男性，85% 为亚洲人，中位基线 HBsAg 水平为 705 (214-2325) IU/ml。 109/110 名患者发生病毒学再激活，中位检测时间为 8 (4-12) 周，并且在停止 TDF 与 ETV 后更早发生（中位 4 与 12 周 p < 0.001）。在第 96 周，77 名 (70%) 仍然停止治疗，65 名 (59%) 的 ALT <2× ULN，31 名 (28%) 的患者疾病缓解，HBVDNA <2000 IU/ml 加 ALT <2× ULN 和7 (6%) 名患者 HBsAg 消失。基线 HBsAg ≤10 IU/ml 与 HBsAg 消失相关（6/9 vs. 1/101 p < 0.001）。 35 例（32%）发生 ALT >5× ULN； ALT 耀斑与 HBsAg 消失无关。没有意外的安全问题。

结论：与 ETV 相比，停止 NA 治疗后病毒学再激活非常常见，并且在停止 TDF 后更早发生。大多数患者在第 96 周时 ALT <2× ULN，但只有三分之一的患者疾病缓解，HBsAg 消失很少见。基线时非常低的 HBsAg 水平并不常见，但可以预测 HBsAg 消失和疾病缓解。

© 2022 John Wiley & Sons Ltd.

StephenW

Stopping nucleot(s)ide analogues in non-cirrhotic HBeAg-negative chronic hepatitis B patients: HBsAg loss at 96 weeks is associated with low baseline HBsAg levels
Samuel A L Hall  1   2 , Gareth S Burns  1   2 , Despina Anagnostou  1 , Sara Vogrin  2 , Vijaya Sundararajan  2   3 , Dilip Ratnam  4   5 , Miriam T Levy  6 , John S Lubel  7   8 , Amanda J Nicoll  9 , Simone I Strasser  10   11 , William Sievert  4   5 , Paul V Desmond  1 , Meng C Ngu  12 , Peter Angus  13   14 , Marie Sinclair  13 , Christopher Meredith  15 , Gail Matthews  16 , Peter A Revill  17 , Kathy Jackson  17 , Margaret Littlejohn  17 , D Scott Bowden  17 , Stephen A Locarnini  17 , Kumar Visvanathan  1   2 , Alexander J Thompson  1   2
Affiliations
Affiliations

    1
    Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.
    2
    Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia.
    3
    The Department of Public Health, La Trobe University, Melbourne, Australia.
    4
    Gastroenterology & Hepatology Unit, Monash Health, Melbourne, Australia.
    5
    Monash University, Melbourne, Australia.
    6
    Gastroenterology Department of Liverpool Hospital, Sydney, Australia.
    7
    Department of Gastroenterology, Alfred Health, Melbourne, Australia.
    8
    Central Clinical School, Monash University, The Alfred Centre, Melbourne, Australia.
    9
    Gastroenterology Department of Eastern Health, Melbourne, Australia.
    10
    AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
    11
    University of Sydney, Sydney, Australia.
    12
    Gastroenterology Department of Concord Repatriation General Hospital, Sydney, Australia.
    13
    Department of Gastroenterology & Hepatology, Austin Health, Melbourne, Australia.
    14
    University of Melbourne, Melbourne, Australia.
    15
    Gastroenterology Department of Bankstown-Lidcombe Hospital, Sydney, Australia.
    16
    Department of infectious Disease, St Vincent's Hospital Sydney, Sydney, Australia.
    17
    Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia.

    PMID: 35521992 DOI: 10.1111/apt.16968

Abstract

Background and aims: Current guidelines recommend long-term nucleot(s)ide analogue (NA) therapy for patients with HBeAg-negative chronic hepatitis B (CHB). However, disease remission has been described after stopping NA therapy, as well as HBsAg loss.

Methods: We performed a prospective multi-centre cohort study of stopping NA therapy. Inclusion criteria were HBeAg-negative CHB, the absence of cirrhosis and HBVDNA<lower limit of quantification for ≥18 months. We assessed virological and biochemical outcomes including HBsAg loss, as well as NA restart rates, over 96 weeks.

Results: In total, 110 patients [62% entecavir (ETV); 28% tenofovir (TDF), 10% other] were enrolled. Median age was 56 years, 57% were male, 85% were Asian, median baseline HBsAg level was 705 (214-2325) IU/ml. Virological reactivation occurred in 109/110 patients, median time to detection was 8 (4-12) weeks, and occurred earlier after stopping TDF versus ETV (median 4 vs. 12 weeks p < 0.001). At week 96, 77 (70%) remained off-treatment, 65 (59%) had ALT <2× ULN, 31 (28%) patients were in disease remission with HBVDNA <2000 IU/ml plus ALT <2× ULN and 7 (6%) patients had lost HBsAg. Baseline HBsAg ≤10 IU/ml was associated with HBsAg loss (6/9 vs. 1/101 p < 0.001). ALT >5× ULN occurred in 35 (32%); ALT flares were not associated with HBsAg loss. There were no unexpected safety issues.

Conclusion: Virological reactivation was very common after stopping NA therapy and occurred earlier after stopping TDF versus ETV. The majority of patients had ALT <2× ULN at week 96, but only one-third achieved disease remission and HBsAg loss was rare. Very low HBsAg levels at baseline were uncommon but predicted for HBsAg loss and disease remission.

© 2022 John Wiley & Sons Ltd.

乙肝人1949

乙肝人1949

了？？嗯哼哼哼哈嘿~哦吼我在这了没