Editor's note: Whether patients with chronic hepatitis B can safely discontinue serum HBsAg after receiving oral nucleos(t)ide analogue therapy has attracted much clinical attention. Although international guidelines recommend that these patients can try to discontinue the drug, many patients develop HBsAg relapse soon after discontinuation, with or without HBVDNA rebound. On March 27~31, 2024, the 33rd Annual Meeting of the Asia-Pacific Association for the Study of the Liver (APASL 2024) was held in Kyoto, Japan.
▲Professor Chen Enqiang made a report on behalf of the team
Background and purpose
Clinical cure is the ideal treatment goal recommended by the current guidelines for the prevention and treatment of chronic hepatitis B (CHB) at home and abroad, which can minimize the risk and adverse outcomes of liver cancer in patients. At present, it is believed that clinical cure refers to the state that treated CHB patients still remain negative for hepatitis B surface antigen (HBsAg) (with or without the presence of hepatitis B surface antibody), undetectable HBV-DNA, and normal liver function indicators after stopping treatment. The purpose of this study was to investigate the HBsAg negative maintenance rate and possible predictors of HBsAg discontinuation in non-cirrhotic CHB patients with long-term nucleos(t)ide analogue (NUC) therapy.
Research Methods:
This is a single-center retrospective study of patients with CHB who are non-cirrhosis patients treated with NUC and who have achieved HBsAg negative conversion, and these patients are treated with hepatitis outpatient clinics in West China Hospital of Sichuan University and have long-term follow-up. Patients with CHB were required to have complete demographic and clinical data, and all patients who discontinued the drug were tested for serum HBVRNA and HBcrAg at the time of discontinuation. Serum HBVRNA detection uses the HBV RNA quantitative detection kit based on the RNA capture probe method (Shanghai Rendu Biotechnology Co., Ltd.) and the supporting AutoSAT automatic detection platform. The detection of serum HBcrAg mainly uses chemiluminescence enzyme immunoassay (CLEIA), and the detection kit is provided by Fuji Rebio Co., Ltd. in Japan.
Findings:
A total of 137 patients with non-cirrhosis CHB with negative HBsAg conversion were screened, 83 patients refused to discontinue the drug, and only 54 patients agreed to discontinue the drug. Among the 54 patients who agreed to discontinue the drug, 43 were males and 11 were females, 42 were HBeAg positive and 12 were HBeAg-negative before antiviral therapy, 44 were continuous monotherapy, and 10 were treated with combination therapy. Among the patients who continued monotherapy, 5 were treated with LAM, 9 were treated with ADV, 4 were treated with LdT, 21 were treated with ETV, 11 were treated with TDF, and 4 were treated with TAF. Among the patients treated with the combination, 6 cases were treated with ETV+TDF and 4 cases were treated with ETV+TAF. All patients were treated on antiviral therapy for more than 5 years. Among the 54 patients who agreed to discontinue the drug, 79.6% (43/54) of the patients had HBsAb positivity at the time of discontinuation, and 59.3% (32/54) of the patients had surface antibody levels above 200 IU/ml. At 24 weeks after drug withdrawal, 3.7% (2/54) of patients developed HBsAg relapse, and 48 weeks after drug discontinuation, 9.3% (5/54) of patients developed HBsAg relapse, and 3 patients were also positive for serum HBVDNA. In the 54 patients who agreed to discontinue the drug, the HBVRNA was lower than the lower limit of detection at the time of drug discontinuation, and 87.0% (47/54) of the patients had serum HBcrAg <3 log10 U/mL. Patients who had HBsAg relapse within 1 year after drug discontinuation had serum HBcrAg greater than 3 log10 U/mL at the time of drug withdrawal.
Conclusions of the study
Patients with non-liver cirrhosis who have obtained HBsAg negative conversion after long-term NUC treatment have a high maintenance rate of negative serum HBsAg after drug withdrawal, and the serum HBcrAg level at the time of drug withdrawal may be related to whether the patients can maintain negative serum HBsAg after drug withdrawal.
原文链接：En-Qiang Chen, Yu-Jing Li, Cheng-Run Song, Lan-Qing Li, Jing Zhou, Meng-Lan Wang, Ya-Chao Tao, Dong-Bo Wu, Wei Jiang, Yong-Hong Wang, Hong Tang. CHB patients receiving NAs therapy and achieving HBsAg loss can safely discontinue medication. APASL 2024 Abstract O-0090.
Previous Review
▶ Prof. Enqiang Chen's team: Liver fibrosis and health-related quality of life in patients with persistently normal ALT HBeAg-negative patients丨APASL 2024
▶ Prof. Chen Enqiang's team: The incidence of tubular absorption impairment in the treatment of chronic hepatitis B with NUC combined with Peg-IFNα is high, and it needs to be paid attention to in clinical practice丨APASL 2024
▶ Professor Chen Enqiang's team: Emitenofovir (TMF) can be used for LLV salvage therapy, and the clinical significance of changes in blood lipid metabolism still needs to be elucidated丨APASL 2024
▶ Prof. Enqiang Chen's team: N-acetylcysteine can accelerate the recovery of cholestatic drug-induced liver damage丨APASL 2024
Source: Editorial Board of International Liver Disease