©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Exploration of nucleos(t)ide analogs cessation in chronic hepatitis B patients with hepatitis B e antigen loss
Yan Xue, Meng Zhang, Tao Li, Feng Liu, Li-Xin Zhang, Xiao-Ping Fan, Bao-Hua Yang, Lei Wang
Yan Xue, Meng Zhang, Tao Li, Li-Xin Zhang, Xiao-Ping Fan, Bao-Hua Yang, Lei Wang, Department of Infectious Disease and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Meng Zhang, Department of Hepatology, Jinan Infectious Disease Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250000, Shandong Province, China
Feng Liu, Department of Hepatology, Tianjin Second People’s Hospital, Tianjin 300000, China
Feng Liu, Tianjin Institute of Hepatology, Tianjin 300000, China
Xiao-Ping Fan, Department of Hepatology, Qingdao Sixth People’s Hospital, Qingdao 266100, Shandong Province, China
Author contributions: Xue Y and Zhang M contributed equally to this work; Wang L and Yang BH were senior authors and contributed equally to this work. Wang L and Yang BH contributed to the conception and design of the study; Wang L, Yang BH, Zhang LX, Liu F, Li T, Xue Y, Zhang M and Fan XP contributed to patients inclusion and follow-up; Li T, Xue Y, Zhang M and Fan XP contributed to interpretation of the data; Li T and Liu F contributed to statistical analysis of the data; Xue Y and Zhang M drafted the manuscript; Wang L, Yang BH and Liu F revised the manuscript critically.
Supported by The Shandong Province Natural Science Foundation, No. ZR2019PH052; and the National Key Research and Development Program of China, No. 2017YFC0908104.
Institutional review board statement: The study was reviewed and approved by the Second Hospital of Shandong University Institutional Review Board (Approval No. KYLL-2015(LW)-0002).
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: All authors have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have prepared the manuscript according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lei Wang, MD, Professor, Department of Infectious Diseases and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Road, Jinan 250033, Shandong Province, China. firstname.lastname@example.org
Received: January 14, 2021
Peer-review started: January 14, 2021
First decision: February 10, 2021
Revised: February 21, 2021
Accepted: March 17, 2021
Article in press: March 17, 2021
Published online: April 14, 2021
Nucleos(t)ide analogs (NAs) cessation in chronic hepatitis B (CHB) patients remains a matter of debate in clinical practice, especially in patients who fail to achieve hepatitis B e antigen (HBeAg) seroconversion after the long-term loss of HBeAg. Few studies were explicitly designed for this subpopulation.
To determine whether chronic hepatitis B patients with HBeAg loss could discontinue NAs after long-term consolidation.
We investigated the outcomes and factors associated with HBeAg-positive CHB patients with HBeAg loss [without hepatitis B e antibody (HBeAb)] after cessation of NAs.
Patients who discontinued NAs after achieving HBeAg loss (without HBeAb) for long periods were included and predictive factors were explored. CHB patients who achieved HBeAg seroconversion were also included for controls.
HBeAg-positive CHB patients with HBeAg loss maintained acceptable virological response after NAs cessation, especially in patients with hepatitis B surface antigen (HBsAg) at cessation < 100 IU/mL. After PSM, the cumulative relapse rates were higher than those in patients with HBeAg seroconversion. More extended consolidation periods (≥ 24 mo) and low HBsAg at cessation (< 100 IU/mL) predicted better response after NAs cessation.
HBeAg-positive CHB patients with HBeAg loss may be able to discontinue NAs therapy after long-term consolidation, especially in patients with HBsAg at cessation < 100 IU/mL.
HBeAg-positive CHB patients with HBeAg loss may be able to discontinue NAs therapy after long-term consolidation and lower HBsAg at cessation is preferred. Careful monitoring, especially in the early stages after cessation, may ensure a favorable outcome.