Clinical outcomes and predictors for relapse after cessation of oral antiviral treatment in chronic hepatitis B patients

• Published in: Journal of gastroenterology 2016-08, Vol.51 (8), p.830-839
• Main Authors: Jung, Kyu Sik, Park, Jun Yong, Chon, Young Eun, Kim, Hyon-Suk, Kang, Wonseok, Kim, Beom Kyung, Kim, Seung Up, Kim, Do Young, Han, Kwang-Hyub, Ahn, Sang Hoon
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adefovir dipivoxil; Administration, Oral; Adult; Age Factors; Aged; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Biliary Tract; Clinical outcomes; Colorectal Surgery; Development and progression; DNA, Viral - blood; Drug Administration Schedule; Drug therapy; Female; Gastroenterology; Guanine - administration & dosage; Guanine - analogs & derivatives; Guanine - therapeutic use; Hepatitis B; Hepatitis B e Antigens - blood; Hepatitis B Surface Antigens - blood; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B virus - isolation & purification; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - virology; Hepatology; Humans; Lamivudine; Lamivudine - administration & dosage; Lamivudine - therapeutic use; Liver; Male; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Original Article—Liver; Pancreas; Patient outcomes; Prognosis; Prospective Studies; Recurrence; Risk Factors; Surgical Oncology; Treatment Outcome; Withholding Treatment; Young Adult
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-015-1153-1

Background Little is known about stopping rules of nucelos(t)ide analog (NA) treatment for chronic hepatitis B (CHB). Methods A total of 113 consecutive patients with CHB (45 HBeAg-positive and 68 HBeAg-negative CHB patients), who met the cessation criteria of NA treatment as per the Asian-Pacific Association for the Study of the Liver (APASL) guideline, were enrolled in this prospective cohort study. The primary endpoint was to evaluate virological relapse (VR) rate within 1 year, which was defined as reappearance of hepatitis B virus (HBV)–DNA > 2000 IU/mL after cessation of NA treatment. In this cohort, entecavir was used in 81 (71.7 %) and lamivudine in 32 (28.3 %) patients. Results Within 1 year after NA treatment, VR occurred in 26 (57.8 %) HBeAg-positive patients and in 37 (54.4 %) HBeAg-negative patients. In univariate and subsequent multivariate analysis, age > 40 years [odds ratio (OR) 10.959; 95 % confidence interval (CI) 2.211–54.320; P  = 0.003) and a pre-treatment HBV DNA level >2000,000 IU/mL (OR 9.285; 95 % CI 1.545–55.795; P  = 0.036) were identified as independent risk factors for VR in HBeAg-positive patients, and age > 40 years (OR 6.690; 95 % CI 1.314–34.057; P  = 0.022) and an end-of-treatment HBcrAg level >3.7 log IU/mL (OR 3.751; 95 % CI 1.187–11.856; P  = 0.024) were identified in HBeAg-negative patients. During follow up, neither hepatic decompensation nor hepatocellular carcinoma (HCC) occurred, and HBV DNA suppression was achieved in all patients who received antiviral re-treatment. Conclusion Our data suggested that the APASL stopping rule could be applied if a candidate was properly selected using individual risk factors. However, regular monitoring should be performed after cessation of NA treatment and long-term outcomes need to be evaluated further.