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Clinical Consequences of Hepatitis B Surface Antigen Loss in Chronic Hepatitis B Infection: A Systematic Literature

Eleonora Morais1, Lauren Mason2, John Dever3

  • 1Epidemiology, Value Evidence & Outcomes, GSK, London, UK.

Gastro Hep Advances
|August 12, 2024
PubMed

Insights

Hepatitis B surface antigen (HBsAg) loss significantly reduces the risk of cirrhosis, liver decompensation, liver cancer, and liver-related death in chronic hepatitis B patients. Achieving HBsAg loss is crucial for better long-term outcomes.

Area of Science:

  • Hepatology
  • Virology
  • Clinical Medicine

Background:

  • Chronic hepatitis B virus (HBV) infection management aims for functional cure, defined by sustained hepatitis B surface antigen (HBsAg) loss post-treatment.
  • HBsAg loss is the optimal treatment endpoint for chronic HBV infection.

Purpose of the Study:

  • To systematically review and meta-analyze the association between HBsAg loss and long-term clinical outcomes in chronic HBV infection.
  • To assess the impact of HBsAg loss on the incidence of cirrhosis, hepatic decompensation, hepatocellular carcinoma, and mortality.

Main Methods:

  • A systematic literature review of Medline and Embase was conducted.
  • Bayesian hierarchical commensurate prior meta-analyses synthesized data from 38 studies (50,354 patients) on HBsAg status and clinical outcomes.
  • Outcomes included cirrhosis, hepatic decompensation (HD), hepatocellular carcinoma (HCC), liver-related mortality (LRM), and all-cause mortality (ACM).

Main Results:

  • HBsAg loss was associated with significantly reduced incidence rates for HD (IRR 0.13), HCC (IRR 0.27), and LRM (IRR 0.17) compared to HBsAg persistence.
  • A trend towards reduced risk was observed for cirrhosis (IRR 0.28) and all-cause mortality (IRR 0.64).
  • The direction of reduced risk associated with HBsAg loss was consistent across subgroups, though the magnitude varied.

Conclusions:

  • HBsAg loss is strongly associated with a reduced risk of major adverse clinical outcomes in chronic hepatitis B.
  • These findings underscore the importance of developing novel strategies to achieve HBsAg loss for improved patient prognosis.
  • The study validates HBsAg loss as a critical therapeutic goal in chronic HBV management.
Abstract

Keywords:
BiomarkerChronic HBV InfectionClinical OutcomesHBsAg LossMeta-Analysis

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