Turkish Journal of Gastroenterology
Poster

Clinical outcomes after cessation of potent antiviral treatment in chronic hepatitis B patients

1.

Department of Internal Medicine, University of Ankara Medical School, Ankara, Turkey

2.

Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey

3.

Hepatology Institute, University of Ankara,Ankara, Turkey

Turk J Gastroenterol 2019; 30: 81-82
DOI: 10.5152/tjg.2019.54
Read: 89 Downloads: 6 Published: 25 July 2019

Abstract

 

INTRODUCTION: The aims of the present study were to assess the rates of hepatitis B virus (HBV) reactivation and to identify the predictors of relapse in CHB who discontinued entecavir (ETV) or tenofovir disoproxil fumarate (TDF) therapy.

METHODS: Between January 2015 and January 2017,36 non-cirrhotic chronic hepatitis B (CHB) patients who had received TDF or ETV for ≥ 5 years (serum HBV DNA negative for ≥ 2 years,a liver stiffness <9 kPa using FibroScan) discontinued nucleoside/nucleotide analogues(NAs) therapy, were prospectively followed. After cessation of NAs therapy, the patients were followed up every month in the first year and then every 3-months along with standard laboratory tests including serum alanine aminotransferase (ALT), HBsAg and HBV DNA measurements. Serum HBsAg quantification was carried out at treatment discontinuation and every 3 months using the Roche Diagnostic Elecsys Kit. Relapse was defined as an episode of serum ALT elevation >2 × upper limit of normal and HBV DNA ≥20.000 IU/mL in two consecutive measurements that were at least 1 months apart after stopping NAs therapy.The median off treatment follow up duration was 26 months.

RESULTS: NAs treatment was discontinued in 36 patients(median age:53 years;25 males/11 females).At the treatment cessation, 32 patients had TDF and 4 patients had ETV therapy.CHB patients had been treated with NAs for a median duration of 77 months.Twenty-six patients had previously received other anti-HBV treatments for CHB, while 10 patients had no treatment. During the follow-up period, no patient died, developed jaundice or liver decompensation due to HBV reactivation.Relapse was occurred in 9 patients;6 of them had relapsed in the first 6 months. The cumulative relapse rates were 2,8% at 3 months, 16,7% at 6 months, 22,1% at 12 months and 26,1% at 24 months, respectively.No significant differences in terms of HBV reactivation including age, gender, the duration of NA treatment, type of antiviral therapy, baseline serum ALT and HBVDNA levels, histological activity index and a liver stiffness and at the end of treatment quantitative HBsAg levels among patients with/without HBV reactivation. HBsAg quantitative values decrease in all patients. The ratio of CHB patients with HBsAg <100 IU / ml were 0 %, 8.6%, 12% and 23.5% at the treatment cessation, at 6 months, at 12 months and at 24 months, respectively. One patient had experienced HBsAg loss after treatment cessation.

CONCLUSION: The present study showed that long-term ETV/TDF therapy with can be safely discontinued in non-cirrhotic CHB patients. HBsAg loss was rarely observed.This is probably associated with being CHB patients infected with genotype D in Turkey.

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