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Great and rapid HB sAg decline in patients with on‐treatment hepatitis flare in early phase of potent antiviral therapy
Author(s) -
Jeng W.J.,
Chen Y.C.,
Liaw Y.F.
Publication year - 2018
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12833
Subject(s) - medicine , gastroenterology , entecavir , hbsag , chronic hepatitis , hepatitis b virus , immunology , virus , lamivudine
Summary HB sAg decline during nucleos(t)ide analogue therapy in chronic hepatitis B with lower pretherapy ALT is usually small and slow. This study aimed to investigate why ~10% of such patients showed “rapid HB sAg decline” ≥0.5 log 10 IU / mL by month 6 of therapy. Patients with persistent pretherapy ALT <5X ULN who had qHBsA g at baseline, months 6 and 12 of entecavir or tenofovir therapy were studied. “On‐treatment ALT elevation” was defined as >10% increase above baseline to >2X ULN during first 6 months of therapy. Of the 256 patients treated, 51 experienced transient “on‐treatment ALT elevation” [group A], including 30 (11.7%) with ALT elevation to 2‐5X ULN [group A‐1] and 21 (8.2%) flared to >5X ULN [group A‐2]. The magnitude of qHBsA g decline and rate of “rapid HB sAg decline” by month 6 was significantly greater and more frequent in group A (−0.446 vs −0.042 log 10 IU / mL ; 45.1 vs 8.8%, respectively, P = 0.000) than in the remaining 205 patients without on‐treatment ALT elevation (group B), being greatest in patients with hepatitis flare (group A‐2: −0.559 log 10 IU / mL and 57.1%, respectively). In patients with therapy ≥2 years, patients with “on‐treatment ALT elevation” also showed significantly greater annual HB sAg decline, more frequent to <100 IU / mL and 4 times higher HB sAg seroclearance rate. “On‐treatment ALT elevation,” especially flare >5X ULN , during entecavir therapy or tenofovir therapy may enhance/accelerate HB sAg decline, suggesting the effect of immune restoration upon potent viral suppression.