停止治疗后乙型肝炎复发率不同

StephenW

停止治疗后乙型肝炎复发率不同
玛丽亚·阿里尼·洛佩兹，PT，DPT，CSCS，CMTPT


根据发表在临床胃肠病学和肝病学上的研究结果，停止使用恩替卡韦或富马酸替诺福韦二吡呋酯 (TDF) 治疗的慢性乙型肝炎病毒 (HBV) 患者经历了不同的复发模式，但乙型肝炎表面抗原丢失和再治疗率相似。

研究人员回顾性分析了 1402 名病毒抑制的慢性 HBV 患者的复发模式，这些患者停止使用恩替卡韦 (n=981) 或 TDF (n=421) 治疗。 2001 年至 2020 年间，患者来自亚洲、北美和欧洲的 13 个中心。

中位随访 18 个月后，96 名 (6.8%)、1097 名 (78%) 和 598 名 (43%) 慢性 HBV 患者出现乙型肝炎表面抗原 (HBsAg) 消失、病毒学复发和临床复发， 分别。在 1402 名患者中，667 名（48%）接受了再治疗。恩替卡韦组和 TDF 组之间的再治疗率没有观察到差异 (P =.14)。

与停用恩替卡韦的患者相比，停用 TDF 的患者 HBsAg 消失率更高（P =.03）；然而，在加权分析后，两组之间的 HBsAg 消失率不再有显着差异 (P =.61)。

停用 TDF 的患者经历了较早的病毒学复发 (P <.01)，伴有丙氨酸转氨酶 (ALT) 肝酶水平升高和临床复发率较高 (P <.01)。与停用恩替卡韦的患者相比，停用 TDF 后出现临床复发的患者的 ALT 峰值水平也更高。

研究作者写道：“我们联合多种族队列的结果表明，TDF 和 [entecavir] 具有不同的复发模式。” “尽管 TDF 撤药后复发率较高，但两组的 HBsAg 消失和再治疗率具有可比性，这表明两组停止治疗后的临床结果相似。”

研究的局限性包括回顾性设计、未知的 HBV 病毒基因型以及缺乏足够的纵向数据使得难以比较治疗组之间的病毒标志物动力学。

披露：一些研究作者宣布与生物技术、制药和/或设备公司有隶属关系。有关作者披露的完整列表，请参阅原始参考资料。
参考

Choi HSJ、Hirode G、Chen CH 等。在慢性乙型肝炎中停用恩替卡韦与富马酸替诺福韦二吡呋酯后的不同复发模式。临床胃肠道肝病。 2022年7月18日在线发表。doi:10.1016/j.cgh.2022.07.005

StephenW

Hepatitis B Relapse Rates Differ After Treatment Discontinuation
Maria Arini Lopez, PT, DPT, CSCS, CMTPT


Patients with chronic hepatitis B virus (HBV) who discontinued treatment with entecavir or tenofovir disoproxil fumarate (TDF) experienced different relapse patterns but similar rates of hepatitis B surface antigen loss and retreatment, according to study findings published in Clinical Gastroenterology and Hepatology.

Researchers retrospectively analyzed patterns of relapse in 1402 virally suppressed patients with chronic HBV, who discontinued treatment using entecavir (n=981) or TDF (n=421). Patients were included from 13 centers throughout Asia, North America, and Europe between 2001 and 2020.

After a median follow-up of 18 months, loss of hepatitis B surface antigens (HBsAg), virological relapse, and clinical relapse occurred in 96 (6.8%), 1097 (78%), and 598 (43%) patients with chronic HBV, respectively. Of the 1402 patients, 667 (48%) received retreatment. There were no observed differences in rate of retreatment between the entecavir and TDF groups (P =.14).

Patients who discontinued TDF demonstrated a higher rate of HBsAg loss (P =.03) than those who discontinued entecavir; however, following weighted analysis, the rate of HBsAg loss was no longer significantly different between the 2 groups (P =.61).

Patients who discontinued TDF experienced earlier virological relapses (P <.01) accompanied by elevated alanine transaminase (ALT) liver enzyme levels and higher rates of clinical relapse (P <.01). Patients who experienced clinical relapse after discontinuing TDF also had higher peak ALT levels compared with patients who discontinued entecavir.

“Findings from our combined multi-ethnic cohort demonstrate that TDF and [entecavir] have differential relapse patterns,” the study authors wrote. “Despite the high rates of relapse occurring earlier after TDF withdrawal, HBsAg loss and retreatment rates in the two groups were comparable, suggesting that clinical outcomes following treatment discontinuation are similar between the two groups.”

Study limitations include the retrospective design, unknown HBV viral genotypes, and lack of adequate longitudinal data making it difficult to compare viral marker kinetics between the treatment groups.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference

Choi HSJ, Hirode G, Chen CH, et al. Differential relapse patterns after discontinuation of entecavir vs tenofovir disoproxil fumarate in chronic hepatitis B. Clin Gastroenterol Hepatol. Published online July 18, 2022. doi:10.1016/j.cgh.2022.07.005