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Sustained response and HBsAg loss after nucleo(s)tide analogue discontinuation in chronic hepatitis B patients: the

Sylvia M Brakenhoff1, Mark Claassen2, Pieter Honkoop3

  • 1Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

Clinics and Research in Hepatology and Gastroenterology
|December 8, 2023
PubMed

Insights

Discontinuing nucleos(t)ide analogues (NA) in selected chronic hepatitis B (CHB) patients may lead to HBsAg loss. However, this carries a significant risk of severe hepatitis, necessitating close patient monitoring.

Area of Science:

  • Hepatology
  • Virology
  • Internal Medicine

Background:

  • Current guidelines permit nucleos(t)ide analogue (NA) cessation before HBsAg loss in select chronic hepatitis B (CHB) patients.
  • The safety and efficacy of NA withdrawal require further investigation in this population.

Purpose of the Study:

  • To evaluate the safety and off-treatment response after nucleos(t)ide analogue (NA) cessation in chronic hepatitis B (CHB) patients.
  • To assess the rate of sustained virologic response and HBsAg loss post-NA discontinuation.

Main Methods:

  • A prospective, multicentre, cohort study involving adult patients with CHB mono-infection.
  • Eligible patients had achieved long-term viral suppression and discontinued NA therapy.
  • Follow-up extended to 96 weeks, with re-treatment criteria for severe hepatitis or liver failure.

Main Results:

  • Out of 33 patients, 45.5% achieved sustained response at 48 weeks, and 39.4% at 96 weeks.
  • Hepatitis B surface antigen (HBsAg) loss was observed in 12.1% of patients by week 96.
  • Severe hepatitis occurred in 21.2% of patients, leading to re-treatment in 36.4%.

Conclusions:

  • Nucleos(t)ide analogue (NA) therapy can be safely discontinued in carefully selected chronic hepatitis B (CHB) patients under close medical supervision.
  • Cessation may enhance the likelihood of HBsAg loss but is associated with a notable risk of severe hepatitis.
Abstract

Keywords:
Functional cure, ALT flareHBV treatmentHBsAg seroconversionTreatment cessation

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