Clinical outcomes of cessation of nucleoside/nucleotide analogues in Chinese patients with HBeAg-negative chronic hepatitis B

Abstract

Background

Cessation of nucleoside/nucleotide analogue (Nuc) therapy in patients with HBeAg-negative chronic hepatitis B (CHB) remains controversial.

Methods

In this prospective, single-center cohort study, we recruited 45 patients with HBeAg-negative CHB from The Fifth Medical Center of Chinese People's Liberation Army General Hospital in mainland China. Patients were classified into a Nuc cessation group (n = 27) and Nuc continuation group (n = 18) and followed-up for 36 months. Nuc were stopped after being inactive for at least 4 years (normal alanine aminotransferase (ALT), undetectable hepatitis B virus (HBV) DNA), with liver fibrosis ≤ Stage1 (S1) and inflammation ≤ Grade (G1).

Results

Within 3 years of follow-up, 51.9% patients with Nuc cessation had virological relapse and 14.8% had ALT elevation, while all patients with Nuc continuation had undetectable HBV DNA and normal ALT. The rate of HBsAg loss after Nuc cessation was 22.2% compared with no seroconversion in patients with Nuc continuation. The hepatitis flare rate was 11.1% and there were no cases of hepatic decompensation after Nuc cessation. End of treatment (EOT) HBsAg, HBV RNA, and decline in HBV core-related antigen (HBcrAg) rate were predictive markers for HBsAg seroconversion at 6 months post-Nuc cessation.

Conclusions

This study showed favorable HBsAg loss and low hepatitis flare rates after Nuc cessation. EOT HBsAg, HBV RNA, and decline in HBcrAg rate were predictive markers for HBsAg seroconversion at 6 months post-Nuc cessation.