Current Trend in Antiviral Therapy for Chronic Hepatitis B

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Stem Cell-Derived Viral Ag-Specific T Lymphocytes Suppress HBV Replication in Mice
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Stem Cell-Derived Viral Ag-Specific T Lymphocytes Suppress HBV Replication in Mice

Published on: September 25, 2019

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Rong-Nan Chien1, Yun-Fan Liaw1

  • 1Liver Research Unit, Chang Gung Memorial Hospital and University College of Medicine, 199 Tung Hwa North Road, Taipei 105, Taiwan.

Viruses
|February 26, 2022
PubMed

Insights

Finite nucleos(t)ide analogue (NUC) therapy for chronic hepatitis B (CHB) shows promise for increasing hepatitis B surface antigen (HBsAg) loss rates. Careful monitoring and timely retreatment decisions are crucial to manage potential off-NUC relapses and ensure patient safety.

Area of Science:

  • Hepatology
  • Virology
  • Immunology

Background:

  • Chronic hepatitis B (CHB) treatment aims to suppress hepatitis B virus (HBV) replication to prevent liver disease progression.
  • Current first-line therapies (Peg-IFN, ETV, TDF, TAF) suppress HBV DNA but rarely achieve HBsAg loss due to lack of action on cccDNA.
  • Long-term nucleos(t)ide analogue (NUC) therapy raises concerns regarding cost, adherence, and loss-to-follow-up.

Purpose of the Study:

  • To evaluate the efficacy and safety of finite NUC therapy in CHB patients.
  • To explore the potential for increased HBsAg loss rates with a treatment-free approach.
  • To establish optimal strategies for monitoring and managing potential relapses after NUC discontinuation.

Main Methods:

  • Review of studies, primarily from Taiwan, investigating finite NUC therapy durations (2-3 years) in HBeAg-negative CHB patients.
  • Analysis of HBsAg loss rates and safety profiles associated with finite NUC regimens.
  • Assessment of monitoring and retreatment strategies, emphasizing the role of HBsAg/ALT kinetics during flares.

Main Results:

  • Finite NUC therapy in HBeAg-negative patients demonstrates feasibility, safety, and significantly increased HBsAg loss rates (up to 30% over 5 years).
  • This approach represents a paradigm shift towards finite treatment strategies in CHB management.
  • Off-NUC relapses and hepatitis flares can occur, necessitating vigilant monitoring and prompt retreatment decisions.

Conclusions:

  • Finite NUC therapy offers a promising strategy to achieve higher HBsAg loss rates in HBeAg-negative CHB patients.
  • Careful patient monitoring, assessment of HBsAg/ALT kinetics, and timely retreatment are critical for managing relapses and ensuring safety.
  • This finite therapy approach sets a benchmark for the development of new anti-HBV drugs aiming for HBsAg loss.

Keywords:
HBsAg losschronic hepatitis Bcombined HBsAg/ALT kineticsfinite NUC therapynucleos(t)ide analogue (NUC)off-NUC flare

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