2021 Webinar: To Stop or Not to Stop: The Practice of Finite Nucleos(t)ide Analog Therapy-To Stop or Not to Stop: The Practice of Finite Nucleos(t)ide Analog Therapy

Video Transcription

Video Summary

In this ASLD webinar, experts discussed the practice of finite nucleoside nucleotide analog therapy in patients with chronic hepatitis B. The lack of effective nucleoside analogs on covalently closed circular DNA and integrated HPV DNA means that chronic hepatitis B cannot be cured. Treatment guidelines recommend only discontinuing nucleoside analog therapy once surface antigen loss is achieved. However, interest in stopping antiviral therapy was rekindled after a study reported a high rate of surface antigen loss, 39%, after stopping continuous therapy. The experts presented evidence supporting both finite therapy and continued therapy. Dr. Jiang argued for finite therapy, citing patient willingness, adherence, and cost concerns. She also highlighted that hepatitis B surface antigen decline is slow during treatment, and the medication cost for lifelong treatment is a concern. Dr. Janssen argued against stopping therapy, noting the significant benefits of antiviral therapy in improving liver fibrosis, reversing cirrhosis, reducing liver cancer risk, and decreasing liver-related mortality. He also mentioned the risk of ALT flares and the potential for dangerous flares and decompensation after stopping therapy. The experts discussed the timing of retreatment after clinical relapse, with Dr. Jiang emphasizing the importance of strict monitoring and a patient's ALT level. Dr. Janssen highlighted the need for standardized retreatment criteria and the challenge of balancing safety and achieving surface antigen loss. They both agreed that long-term follow-up and more data are needed to make definitive recommendations.

Asset Caption

Presenters: Wen-Juei Jeng, MD and Harry Janssen, MD, PhD, FAASLD
Moderators: Marc Ghany, MD, FAASLD and Yao-Chun Hsu, MD, MSc, PhD

Keywords

ASLD webinar

finite nucleoside nucleotide analog therapy

chronic hepatitis B

nucleoside analogs

covalently closed circular DNA

integrated HPV DNA

surface antigen loss

antiviral therapy

liver fibrosis

cirrhosis

liver cancer risk