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Systematic review: cessation of long‐term nucleos(t)ide analogue therapy in patients with hepatitis B e antigen‐negative chronic hepatitis B
Author(s) -
Chang M.L.,
Liaw Y.F.,
Hadziyannis S. J.
Publication year - 2015
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13272
Subject(s) - medicine , hbsag , gastroenterology , hbeag , hepatitis b , cirrhosis , chronic hepatitis , hepatitis b virus , immunology , virus
Summary Background It has been debated whether finite nucleos(t)ide analogue therapy is feasible in HB eAg‐negative chronic hepatitis B. Aim To review this issue systematically. Methods Using text terms HB sAg and various nucleos(t)ide analogues, PubMed was searched between 1995 and 2014 to find studies on therapy >6 months in adult HB eAg‐negative chronic hepatitis B patients with off‐therapy follow‐up >6 months. Results Twenty‐two studies with a total of 1732 patients were identified and included. The median duration of therapy, consolidation therapy and off‐therapy follow‐up ranged from 6 months to 8 years, 4 to 96 weeks and 6 to 80 months respectively. Patients were monitored with serum ALT and HBV DNA monthly in the first 1–3 months and every 3–6 months afterwards in most studies. The 1‐year off‐therapy ‘virological relapse’ ( HBV DNA >2000 IU / mL ) and ‘clinical relapse’ ( HBV DNA > 2000 IU / mL + ALT elevation) occurred in <70% and <50% of the patients, respectively, and <40% of the patients received re‐treatment. These rates were higher in patients with shorter treatment, shorter consolidation therapy and those treated with less potent nucleos(t)ide analogues. Off‐therapy severe flares were rare and hepatic decompensation was reported in only one patient with cirrhosis. Biochemical relapse reflecting enhanced immune‐mediated hepatocyte killing may lead to a higher chance for off‐therapy HB sAg seroclearance and be possibly desirable. Conclusion With an appropriate stopping rule and a proper off‐therapy monitoring plan, cessation of long‐term nucleos(t)ide analogue therapy prior to HB sAg seroclearance in HB eAg‐negative chronic hepatitis B is a feasible alternative to indefinite treatment.