Hepatitis B Surface Antigen Seroclearance Rate After Stopping Nucleos(t)ide Analogues in Chronic Hepatitis B—A Systematic Review and Meta-Analysis

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology Pub Date : 2025-03-05 DOI:10.1111/jgh.16920

Soe Thiha Maung, Pakanat Decharatanachart, Roongruedee Chaiteerakij

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引用次数: 0

Abstract

Aim

To identify factors influencing HBsAg seroclearance rates after stopping nucleos(t)ide analogue (NA) therapy in patients with chronic hepatitis B (CHB).

Methods

We conducted a comprehensive literature search in databases from inception to July 2024. Subgroup analyses and meta-regression were performed to determine factors associated with HBsAg seroclearance, including ethnicity, HBV genotype, NA therapy duration, end-of-treatment (EOT) qHBsAg levels, HBeAg status, cirrhosis status, and follow-up duration.

Results

The meta-analysis included 62 studies (n = 9867) with a pooled HBsAg seroclearance rate of 10% (95%CI: 8%–12%, I² = 92%) after NA cessation. HBeAg-negative patients showed significantly higher rates than HBeAg-positive patients (11% vs. 5%, p = 0.030). Subgroup analysis revealed higher seroclearance with follow-up of >5 years (18%, p = 0.004), showing significantly higher rates were observed in studies with longer follow-up periods. Caucasians showed a higher rate (12%) than Asians (9%, p = 0.067). Studies adhering to AASLD, EASL, or APASL stopping rules showed no significant differences in rates. Patients with EOT qHBsAg ≤2.0 log IU/mL had higher rates (23%) than those with >2.0 log IU/mL (11%). Re-treated patients had lower seroclearance (6%) compared to those not re-treated (17%, p = 0.178). Meta-regression identified ethnicity, HBeAg status, and follow-up duration as significant contributors to heterogeneity. Egger's test showed no evidence of publication bias (p = 0.1928).

Conclusion

Our meta-analysis highlights the role of ethnicity, EOT qHBsAg levels, HBeAg-status, and follow-up duration in determining HBsAg seroclearance rates. These findings stress the need for personalized NA discontinuation strategies and further research on HBV genotypes and biomarkers to improve treatment outcomes and predict seroclearance more accurately.

Abstract Image

查看原文本刊更多论文

慢性乙型肝炎停止核苷类似物后乙型肝炎表面抗原血清清除率的系统评价和荟萃分析。

目的：探讨影响慢性乙型肝炎（CHB）患者停止核苷类似物（NA）治疗后HBsAg血清清除率的因素。方法：对数据库从成立到2024年7月进行全面的文献检索。进行亚组分析和meta回归以确定与HBsAg血清清除率相关的因素，包括种族、HBV基因型、NA治疗持续时间、治疗结束（EOT） qHBsAg水平、HBeAg状态、肝硬化状态和随访时间。结果：荟萃分析包括62项研究（n = 9867）， NA停止后HBsAg清除率为10% （95%CI: 8%-12%, I2 = 92%）。hbeag阴性患者的发病率明显高于hbeag阳性患者（11%比5%，p = 0.030）。亚组分析显示，随访50 ~ 50年血清清除率较高（18%,p = 0.004），随访时间越长，清除率越高。白种人的发病率（12%）高于亚洲人（9%,p = 0.067）。坚持AASLD、EASL或APASL停止规则的研究显示，发生率没有显著差异。EOT qHBsAg≤2.0 log IU/mL患者的发生率（23%）高于>2.0 log IU/mL患者（11%）。再次治疗的患者血清清除率（6%）低于未再次治疗的患者（17%,p = 0.178）。meta回归发现种族、HBeAg状态和随访时间是影响异质性的重要因素。Egger检验未发现发表偏倚的证据（p = 0.1928）。结论：我们的荟萃分析强调了种族、EOT qHBsAg水平、hbeag状态和随访时间在决定HBsAg血清清除率中的作用。这些发现强调了个性化NA停药策略和进一步研究HBV基因型和生物标志物的必要性，以改善治疗结果并更准确地预测血清清除率。

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来源期刊

Journal of Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.40%

发文量

326

审稿时长

2.3 months

期刊介绍： Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.