qHBsAg outperforms ALT/qHBsAg ratio in predicting HBsAg seroclearance after cessation of entecavir versus tenofovir
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Published on: June 5, 2020
Hsing-Yun Lee1, Cheng-Yuan Peng2, Kwong-Ming Kee1
1Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Background:
We aimed to establish the optimal value of the alanine aminotransferase (ALT)/quantitative HBsAg (qHBsAg) ratio and qHBsAg level at end of treatment (EOT) to predict HBsAg seroclearance following cessation of entecavir versus tenofovir disoproxil fumarate (TDF) in HBeAg-negative with chronic hepatitis B (CHB) patients.
Material And Methods:
This retrospective cohort study included 715 HBeAg-negative patients without cirrhosis who had previously received entecavir (n = 438) or TDF (n = 277).
Results:
The cumulative incidences of HBsAg seroclearance at 5 and 10 years after cessation of entecavir or TDF were 13.0 % and 33.8 %, respectively. Both a qHBsAg level <100 IU/mL and an ALT/qHBsAg ratio ≥0.2 at EOT were independent predictors of HBsAg seroclearance (p < 0.001). A qHBsAg of 100 IU/mL had significantly lower Akaike information criterion (AIC) and Bayesian information criterion (BIC) values than an ALT/qHBsAg ratio of 0.2 at EOT (AIC: 1273 vs. 1305, BIC: 1276 vs. 1308, both p < 0.001). Additionally, patients who discontinued entecavir therapy had a higher rate of HBsAg seroclearance than patients who discontinued TDF therapy, regardless of qHBsAg ≥100 IU/mL (p = 0.027) or ALT/qHBsAg ratio <0.2 (p = 0.028). The optimal values for predicting HBsAg seroclearance were 300 and 100 IU/mL for qHBsAg and 0.1 and 0.2 for the ALT/qHBsAg ratio after stopping entecavir versus TDF, respectively.
Conclusions:
A qHBsAg level <100 IU/mL at EOT is better predictor of HBsAg seroclearance than an ALT/qHBsAg ratio ≥0.2. Compared to TDF, entecavir was associated with higher rates of HBsAg seroclearance in patients with higher qHBsAg level or a lower ALT/qHBsAg ratio at EOT.
