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Long‐term clinical outcome of HBeAg‐negative chronic hepatitis B patients who discontinued nucleos(t)ide analogues
Author(s) -
Manolakopoulos Spilios,
Kranidioti Hariklia,
Kourikou Anastasia,
Deutsch MelanieMaria,
Triantos Christos,
Tsolias Chrysostomos,
Manesis Emanuel K.,
Mathou Nicoletta,
Alexopoulou Alexandra,
Hadziyannis Emilia,
Papatheodoridis George
Publication year - 2021
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14654
Subject(s) - medicine , discontinuation , gastroenterology , entecavir , hepatocellular carcinoma , hbsag , hbeag , hepatitis b , hepatitis b virus , cirrhosis , surgery , immunology , virus , lamivudine
Background & Aims Discontinuation of nucleos(t)ide analogues (NA) remains a debatable issue in HBeAg‐negative chronic hepatitis B (CHB). This study aimed to address the outcome of HBeAg‐negative CHB patients who discontinued NA therapy. Methods This prospective study included 57 non‐cirrhotic HBeAg‐negative Caucasian CHB patients who discontinued NA therapy after median virological remission of 6 years. All patients had regular blood tests. Virological relapse was defined as HBV DNA > 2000 IU/mL or >20 000 IU/mL and biochemical relapse as ALT > ULN (40 IU/mL) or >2xULN. All patients with retreatment predefined criteria restarted entecavir or tenofovir. Results Of the 57 patients, 29 remained without retreatment after median follow‐up of 65 months (range: 36‐87) following treatment discontinuation. At 3, 6, 12, 24, 36 and 48 months, cumulative rates of retreatment were 16%, 20%, 32%, 35%, 46% and 50%, while the proportion of patients with HBV DNA < 2000 IU/mL and ALT < ULN were 73%, 60%, 52%, 52%, 47% and 37% respectively. All patients had virological and biochemical response after retreatment. No patient developed liver failure, hepatocellular carcinoma or death. Cumulative rates of HBsAg loss were 2%, 4%, 7%, 10% and 20% at 3, 6, 12, 24 and 36 months. HBsAg levels < 100 IU/mL at the end of NA treatment could predict HBsAg loss ( P = .001). Conclusions Our study supports that NA therapy can be safely stopped in non‐cirrhotic patients with HBeAg‐negative CHB. Over a median follow‐up of more than 5 years, half of the patients remained without retreatment with a substantial proportion of them achieving functional cure.