在 HBeAg 阴性慢性乙型肝炎中停止核苷酸类似物治疗：一项荟

StephenW

在 HBeAg 阴性慢性乙型肝炎中停止核苷酸类似物治疗：一项荟萃分析

    http://orcid.org/0000-0001-7158-585XSamuel Anthony Lachlan Hall1、Sara Vogrin2、Olivia Wawryk2、Gareth S Burns1、Kumar Visvanathan2,3、Vijaya Sundararajan4、Alexander Thompson1,2

    致澳大利亚菲茨罗伊圣文森特医院墨尔本私人有限公司 Samuel Anthony Lachlan Hall 博士的信函； [email protected]

抽象的

背景和目的 已经描述了乙型肝炎 e 抗原 (HBeAg) 阴性慢性乙型肝炎 (CHB) 患者在停用核苷类似物 (NA) 后会出现持续的病毒学抑制和乙型肝炎表面抗原 (HBsAg) 丢失。我们对 HBeAg 阴性 CHB 停用 NA 后的临床结果进行了荟萃分析。

方法 纳入中位随访时间≥12 个月的 HBeAg 阴性 CHB 个体停止 NA 的研究。参与者在 NA 开始时为 HBeAg 阴性。对以下临床结果进行了随机效应荟萃分析：（1）6 个月和 12 个月时的病毒学复发（VR）； (2) 6 个月和 12 个月时的临床复发 (CR) 和 (3) HBsAg 消失。使用亚组分析和元回归估计其他变量的影响。包括停用恩替卡韦 (ETV) 和/或富马酸替诺福韦二吡呋酯 (TDF) 的患者的研究与包括停用老一代 NA 的患者的研究分开考虑。

结果 N=37 项研究符合纳入标准。停止 ETV/TDF 后 VR 和 CR 的累积发生率在 6 个月和 12 个月分别为 44% 和 17% 和 63% 和 35%。停止较旧的 NA 后观察到类似的复发率。在停止 ETV/TDF 的患者中，与 ETV 相比，停止 TDF 与增加 6 个月的 CR 率相关。停用老年 NA 时，随访 ≥4 年与 HBsAg 消失率之间存在关联。肝功能失代偿和肝细胞癌很少见，但在包括肝硬化个体在内的研究中更常见。

结论 NA 停药后 VR 很常见，但在 12 个月时仅三分之一的患者出现 CR。停止 NA 治疗后可以清除 HBsAg，并且随着时间的延长，发生率更高。
数据可用性声明

所有与研究相关的数据都包含在文章中或作为补充信息上传。

http://dx.doi.org/10.1136/gutjnl-2020-323979

StephenW

Discontinuation of nucleot(s)ide analogue therapy in HBeAg-negative chronic hepatitis B: a meta-analysis

    http://orcid.org/0000-0001-7158-585XSamuel Anthony Lachlan Hall1, Sara Vogrin2, Olivia Wawryk2, Gareth S Burns1, Kumar Visvanathan2,3, Vijaya Sundararajan4, Alexander Thompson1,2

    Correspondence to Dr Samuel Anthony Lachlan Hall, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia; [email protected]

Abstract

Background and aims Sustained virological suppression and hepatitis B surface antigen (HBsAg) loss have been described after nucleot(s)ide analogue (NA) discontinuation for patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB). We performed a meta-analysis of the clinical outcomes after NA discontinuation for HBeAg-negative CHB.

Methods Studies involving NA cessation in HBeAg-negative CHB individuals with a median follow-up of ≥12 months were included. Participants were HBeAg-negative at the time of NA initiation. Random effects meta-analyses were performed for the following clinical outcomes: (1) virological relapse (VR) at 6 and 12 months; (2) clinical relapse (CR) at 6 and 12 months and (3) HBsAg loss. Effect of other variables was estimated using subgroup analysis and meta-regression. Studies including patients stopping entecavir (ETV) and/or tenofovir disoproxil fumarate (TDF) were considered separately to studies including patients stopping older generation NA.

Results N=37 studies met inclusion criteria. Cumulative incidence of VR and CR after stopping ETV/TDF was 44% and 17% at 6 months and 63% and 35% at 12 months. Similar relapse rates were observed after stopping older NAs. Among patients stopping ETV/TDF, TDF cessation was associated with increased CR rates at 6 months versus ETV. There was an association between follow-up ≥4 years and HBsAg loss rates when stopping older NAs. Hepatic decompensation and hepatocellular carcinoma were rare but occurred more frequently in studies including cirrhotic individuals.

Conclusion VR is common after NA discontinuation, however, CR was only seen in one-third of patients at 12 months. Stopping NA therapy can be followed by HBsAg clearance, and rates are higher with longer follow-up.
Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/gutjnl-2020-323979