Combining age and HBsAg level predicts post‐treatment durability of nucleos(t)ide analogue‐induced HBeAg seroconversion

Background and Aims Previous studies have indicated that lamivudine‐induced hepatitis B e antigen ( HBeAg ) seroconversion may not be durable in the A sian population. We investigated the useful predictors of post‐treatment hepatitis B virus ( HBV ) relapse in patients with nucleos(t)ide analogue ( NA )‐induced HBeAg loss/seroconversion. Methods A total of 157 non‐cirrhotic patients with NA ‐induced HBeAg loss/seroconversion (78, lamivudine; 68, entecavir; 11, telbivudine) were retrospectively analyzed. All patients had at least 12 months of post‐treatment follow‐up and consolidation therapy duration. Results The cumulative rate of post‐treatment HBV relapse at 5 years was 57.1%. Multivariate analysis revealed that age and baseline hepatitis B surface antigen ( HBsAg ) levels independently predicted post‐treatment HBV relapse. The post‐treatment HBV relapse rate was significantly higher in patients aged > 40 years than in those < 40 years ( P  < 0.001). A baseline HBsAg level of 2000 IU /mL was the optimal cut‐off value for predicting post‐treatment HBV relapse ( P  = 0.002). The post‐treatment HBV relapse risk further increased with the presence of both risk factors (age ≥ 40 years and baseline HBsAg level ≥ 2000 IU /mL; P  < 0.001). A prolonged consolidation therapy period of ≥ 18 or 24 months had no positive effect on sustained viral suppression. There was no significant difference in post‐treatment HBV relapse rates between patients with lamivudine‐ and entecavir‐induced HBeAg loss/seroconversion during the off‐treatment follow‐up ( P  = 0.31). Conclusion The combination of an age of 40 years and a baseline HBsAg level of 2000 IU /mL was a useful marker for predicting post‐treatment HBV relapse in patients with NA ‐induced HBeAg loss/seroconversion.