Sustained response and HBsAg loss after nucleo(s)tide analogue discontinuation in chronic hepatitis B patients: the prospective SNAP study - 07/02/24
, Mark Claassen b, Pieter Honkoop c, Robert J. de Knegt a, Annemiek A. van der Eijk d, André Boonstra a, Robert A. de Man a, Milan J. Sonneveld aHighlights |
• | Nucleo(s)tide analogues (NA) can be ceased, but only in a selected group of hepatitis B patients. |
• | After NA cessation, patients should be closely monitored. |
• | Finite NA therapy is associated with a higher number of HBsAg loss, but also with severe hepatic flares. |
Abstract |
Background & Aim(s) |
Current guidelines suggest that nucleos(t)ide analogues (NA) can be discontinued before HBsAg loss in a selected group of chronic hepatitis B (CHB) patients. We aimed to study the safety and off-treatment response after NA cessation.
Methods |
This is a prospective, multicentre, cohort study in which eligible patients discontinued NA therapy. Adult patients, with a CHB mono-infection, HBeAg-negative, without a (history of) liver cirrhosis, who had achieved long-term viral suppression were eligible. Follow-up visits were planned at week 2-4-8-12-24-36-48-72-96. Re-treatment criteria included severe hepatitis (ALT >10x ULN), signs of imminent liver failure (bilirubin >1.5x ULN or INR >1.5), or at the physician's own discretion.
Results |
In total, 33 patients were enrolled. Patients were predominantly Caucasian (45.5%) and had genotype A/B/C/D/unknown in 3/4/6/10/10 (9.1/12.1/18.2/30.3/30.3%). At week 48, 15 patients (45.5%) achieved a sustained response (HBV DNA <2,000 IU/mL). At week 96, 13 patients (39.4%) achieved a sustained response, 4 (12.1%) achieved HBsAg loss, and 12 (36.4%) were re-treated. Severe hepatitis was the main reason for re-treatment (n=7, 21.2%). One patient with severe hepatitis developed jaundice, without signs of hepatic decompensation. Re-treatment was successful in all patients.
Conclusion |
NA therapy can be ceased in a highly selected group of CHB patients if close follow-up can be guaranteed. Treatment cessation may increase the chance of HBsAg loss in selected patients, which is counterbalanced by a significant risk of severe hepatitis.
Le texte complet de cet article est disponible en PDF.Keywords : HBsAg seroconversion, Treatment cessation, HBV treatment, Functional cure, ALT flare
Abbreviations : HBV, CHB, HCC, NA, HBsAg, EASL, HBeAg, IU/mL, HIV, ALT, LLOQ, RCT, INR, U, IU, L, μmol, g
Plan
Vol 48 - N° 2
Article 102257- février 2024 Retour au numéro
Article précédent
- Metabolism-related signalling pathways involved in the pathogenesis and development of metabolic dysfunction-associated steatotic liver disease
- Cheng Xie, Kaiyu Liu, Yixin Xie, Shun Liu, Bai Ji
- The regulatory effect of lncRNA LINC00943 on the progression of hepatocellular carcinoma and its relationship with clinicopathological features
- Xiaoan Qi, Liang Liu
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?