Treatment cessation in noncirrhotic, e-antigen negative chronic hepatitis B is safe and effective following prolonged anti-viral suppression with nucleosides/nucleotides.

Abstract

BACKGROUND:

The treatment of HBeAg-negative chronic hepatitis B (CHB) is considered to be open-ended, with no guidelines for treatment cessation.

AIM:

To evaluate biochemical and virological relapse requiring retreatment in noncirrhotic HBeAg-negative CHB in patients who stopped treatment following a period of prolonged viral suppression with nucleotides/nucleosides.

METHODS:

We performed a single-centre retrospective chart review of patients with HBeAg-negative CHB who maintained viral suppression for 4-5 years on anti-viral treatment, and thus subsequently stopped treatment. The primary end point of composite relapse was defined by an increase in HBV DNA >2000 IU/mL, ALT elevation above 1.25 × normal or doubling of ALT from cessation, and re-initiation of anti-viral therapy.

RESULTS:

We identified 33 patients with HBeAg-negative CHB who stopped treatment following viral suppression. Mean treatment duration was 5.28 ± 2.73 years. Patients were treated with lamivudine (3), adefovir (14), entecavir (4), and tenofovir (12). Eleven (33%) patients met the primary end point of composite relapse. For individual end points, 21 (63%) patients had a viral relapse, 16 (48%) had a biochemical relapse, and 16 (48%) restarted treatment, leaving 17 (52%) patients who remained treatment-free over a median 36 months of follow-up. Lower pre-treatment ALT and detectable HBV DNA within the first month after treatment discontinuation were associated with increased rates of composite relapse (HR 1.01; P = 0.022 for ALT and HR 1.01; P = 0.038 for HBV DNA).

CONCLUSION:

Patients with noncirrhotic HBeAg-negative CHB can stop treatment after greater than 4-5 years of suppressive therapy with nucleosides/nucleotides with more than 50% remaining treatment-free.

• Authors: V R Patwardhan, N Sengupta, A Bonder, D Lau, N H Afdhal
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 40 Issue 7 Pg. 804-10 (Oct 2014) ISSN: 1365-2036 [Electronic] England
• PMID: 25109610 (Publication Type: Journal Article)
• Copyright: © 2014 John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Hepatitis B e Antigens
• Nucleosides
• Nucleotides
• Organophosphonates
• Lamivudine
• entecavir
• Guanine
• adefovir
• Tenofovir
• Adenine

Topics

• Adenine (analogs & derivatives, therapeutic use)
• Adult
• Antiviral Agents (therapeutic use)
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B e Antigens
• Hepatitis B, Chronic (drug therapy)
• Humans
• Lamivudine (therapeutic use)
• Male
• Middle Aged
• Nucleosides (therapeutic use)
• Nucleotides (therapeutic use)
• Organophosphonates (therapeutic use)
• Recurrence
• Tenofovir
• Withholding Treatment
• Young Adult