Current Trend in Antiviral Therapy for Chronic Hepatitis B

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.