Durability of 3-year consolidation therapy following virologic response in chronic hepatitis B patients treated with nuclios(t)ide analogues
AASLD LiverLearning®. Lee K. Nov 14, 2016; 144768
Label: Hepatitis B: Treatment
Prof. Dr. Kwan Sik Lee
Prof. Dr. Kwan Sik Lee
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ABSTRACT FINAL ID: 1876

TITLE: Durability of 3-year consolidation therapy following virologic response in chronic hepatitis B patients treated with nuclios(t)ide analogues

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ABSTRACT BODY:
BACKGROUND/AIM: The durability of response after stopping nucleos(t)ide analogue (NA) therapy in chronic hepatitis B (CHB) patients remains unknown. Although HBsAg loss is to be the ideal goal of NA treatment, it is scarcely achieved especially in HBV genotype C patients. The consolidation therapy before the discontinuation of NA is suggested to be at least one year although the ideal duration of consolidation therapy is yet to be validated. We studied the long term outcome of CHB genotype C patients who discontinued NA therapy after 3 years of consolidation therapy.
METHODS: We retrospectively reviewed the outcomes of 33 HBeAg positive and 54 HBeAg negative CHB genotype C patients who stopped NA after 3-year of consolidation therapy following achievement of undetectable HBV DNA and HBeAg loss (in HBeAg positive patients). Relapse was defined as HBV DNA >2,000 IU/mL measured twice at 6 months apart within one year, or retreatment after the initial HBV DNA elevation.
RESULTS: NAs used for consolidation were lamivudine (15.2%), clevudine (3.0%), entercavir (21.2%), adefovir (24.2%), lamivudine with adefovir (33.3%), or telbivudine with adefovir (3.0%) in HBeAg positive patients, and lamivudine (25.9%), telbivudine (1.9%), clevudine (3.7%), entercavir (42.6%), adefovir (9.3%), or lamivudine with adefovir (16.7%) in HBeAg negative patients. Mean follow-up from discontinuation after 3-year consolidation therapy to final visit was 42.6 months in HBeAg positive patients and 40.8 months in HBeAg negative patients. The final relapse was noted in 63.6 % in HBeAg positive patients and 70.4 % in HBeAg negative patients within 5 years after stopping NA. The cumulative relapse rate was 36.4% at 3 months, 45.5% at 6 months, 54.5% at 1 year, 64.6% at 3 years and 5 years in HBeAg positive patients. The cumulative relapse rate was 26.0% at 3 months, 41.2% at 6 months, 56.9% at 1 year, 75.1% at 3 and 5 years in HBeAg negative patients.
CONCLUSIONS: Even with 3-year consolidation therapy, relapse rate was high regardless of HBeAg status after the discontinuation of NA. This study suggests that CHB patients who discontinue therapy require close monitoring for recurrent hepatitis and restarting treatment.
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