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The safety of stopping nucleos(t)ide analogue treatment in patients with HBeAg-negative chronic hepatitis B

 Grace L-H Wong  ;  Henry L-Y Chan  ;  Becky W-Y Yuen  ;  Yee-Kit Tse  ;  Hester W-S Luk  ;  Terry C-F Yip  ;  Vicki W-K Hui  ;  Lilian Y Liang  ;  Hye-Won Lee  ;  Grace C-Y Lui  ;  Vincent W-S Wong 
 LIVER INTERNATIONAL, Vol.40(3) : 549-557, 2020-03 
Journal Title
Issue Date
Antiviral Agents / adverse effects ; DNA, Viral ; Hepatitis B Surface Antigens ; Hepatitis B e Antigens ; Hepatitis B virus / genetics ; Hepatitis B, Chronic* / drug therapy ; Hong Kong / epidemiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Symptom Flare Up ; Treatment Outcome
antiviral treatment ; chronic hepatitis B ; HBsAg ; HBV
Background The rates of hepatitis B surface antigen (HBsAg) seroclearance after stopping nucleos(t)ide analogues (NA) in European (19% in 2 years) and Asian (13% in 6 years) patients with chronic hepatitis B (CHB) vary dramatically. We evaluated the incidence of hepatitis flare and HBsAg seroclearance in hepatitis B e antigen (HBeAg)-negative Chinese CHB patients who had stopped NA. Methods This was a territory-wide retrospective study in Hong Kong. We identified HBeAg-negative CHB patients from January 2000 to December 2017 who had stopped NA treatment for more than 3 months. Hepatitis flare was defined as ALT >2xULN. Results The 1076 patients were predominantly middle-aged men (mean age 52 years, male 74.8%) when starting NA; they stopped NA after 82 +/- 35 months of treatment. At 44.3 +/- 24.6 months after stopping NA, 147 (13.6%) patients had hepatitis flare, which led to resumption of NA; whereas 77 (7.2%) patients had flare but did not resume NA. Decompensation occurred in 7/914 (0.8%) patients. A total of 695 (64.6%) patients remained on NA treatment at the last visit. Eleven patients had achieved HBsAg seroclearance (6 of them had hepatitis flare and 1 of these 6 patients achieved HBsAg seroclearance after NA was restarted). Hepatic events developed in 75/695 (10.8%) patients who had NA resumed vs 43/381 (11.3%) patients who did not resume NA (P = .677). Conclusions Hepatitis flare and retreatment were common in HBeAg-negative CHB patients who stopped NA treatment; whereas HBsAg seroclearance rarely occurred. Stopping NA to achieve functional cure should not be recommended at this moment.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
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