When can we stop nucleoside analogues in patients with chronic hepatitis B?

Abstract

Treatment with nucleoside analogue ( NA s) is now the most common treatment for chronic hepatitis B ( CHB ) and is recommended by all guidelines. Stopping NA s is a controversial issue in these patients, unless the clinical endpoints of HB eAg seroconversion or HB sAg seroclearance are achieved. While HB eAg seroconversion can occur in a significant number of patients, HB sAg seroclearance rates are low. HB sAg seroclearance is increasingly accepted as the ideal end of treatment, representing a func- tional cure. Treatment withdrawal leads to relapse in 50% of patients who achieve HB eAg seroconversion and complete at least 12 months of consolidation therapy. In HB eAg negative CHB , the Asian Pacific Association for the Study of the Liver ( APASL ) stopping rules show that although clinical relapse occurs in approximately 43% and virological relapse occurs in 70%, very few patients experience flare or decompensation. NA s treatment for >2 years was associated with a lower rate of relapse. Recently, stopping NA therapy was shown to be associated with HB sAg in 20%- 39% of HB eAg negative patients and more frequently in those with low quantitative HB sAg ( qHBsA g). However, the most optimal level is unclear. Quantitative HB sAg is becoming a useful tool to predict a sustained response or relapse before stopping therapy. In conclusion, stopping NA therapy is generally safe and can be an option in specific situa- tions such as HB eAg seroconversion. However, it is associated with disease relapse. Thus, patient selection based on qHB sA g may help identify patients who are more likely to achieve HB sAg seroclearance or a sustained response.

 

K E Y W O R D S
antiviral therapy , cessation , hepatitis B flares , nucleos(t)ide analogues , quantitative HB sAg ,
relapse , seroreversion , treatment withdrawal

About Speaker

Seng Gee LIM

Singapore


Biography of Seng Gee LIM

Professor Seng Gee Lim, FRACP, FRCP, FAMS, MD, is Director of Hepatology at the Division of Gastroenterology and Hepatology, National University Health System, Singapore, and was previously Chief of Division.

He graduated in 1980 from Monash Medical School completed his research MD at the Royal Free Hospital.

He is a member of the editorial boards for Liver International, Journal of Viral Hepatitis, Hepatology International, Alimentary Pharmacology and Therapeutics, Lancet Gastroenterology & Hepatology, and Evidence Based Internal Medicine Solutions, He is also on the advisory board of Gilead
Sciences, Novartis Pharmaceuticals, Bristol Myers Pharmaceuticals, Merck Sharpe and Dohme Pharmaceuticals, Springbank, Abbvie and Abbott Diagnostics.

He is currently chairman of the Singapore Hepatology Conference and Science of HBV cure conference, and was previously the Chairman of the Asia Pacific
Association for Study of the Liver (APASL) Liver Week 2013 Congress. He served as Governing Council member from 2014-2018 of the International Association for Study of Liver (IASL), and has been appointed to the AASLD Asia Pacific Regional Advisory Council in 2018. He is faculty at the Asia
Pacific EBM workshop. His research includes clinical trials of new treatments for chronic hepatitis B and C, and translational research in viral hepatitis, involving molecular biology and immunology of hepatitis B. He has over 207 peer review publications and has been awarded over $36 million in grant funding for his research, including a recent award of a $25 million National Translational Clinical Research grant in 2015 to investigate eradication of HBV. In 2018 he was awarded the NMRC Clinician Scientist Award for research in HBV.

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