Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: a nationwide multicentre study. Issue 12 (24th March 2020)

• Record Type: Journal Article
• Authors: Kim, Minseok Albert; Kim, Seung Up; Sinn, Dong Hyun; Jang, Jeong Won; Lim, Young-Suk; Ahn, Sang Hoon; Shim, Jae-Jun; Seo, Yeon Seok; Baek, Yang Hyun; Kim, Sang Gyune; Kim, Young Seok; Kim, Ji Hoon; Choe, Won Hyeok; Yim, Hyung Joon; Lee, Hyun Woong; Kwon, Jung Hyun; Lee, Sung Won; Jang, Jae Young; Kim, Hwi Young; Park, Yewan; Kim, Gi-Ae; Yang, Hyun; Lee, Han Ah; Koh, Myeongseok; Lee, Young-Sun; Kim, Minkoo; Chang, Young; Kim, Yoon Jun; Yoon, Jung-Hwan; Zoulim, Fabien; Lee, Jeong-Hoon;
• Is Part Of: Gut. Volume 69:Issue 12(2020)
• Page Start: 2214
• Page End: 2222
• Publication Date: 2020-03-24
• Subjects: HBV DNA redetection -- hepatocellular carcinoma -- HBsAg -- antivirals; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-320015
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Direct comparison of the clinical outcomes between nucleos(t)ide analogue (NA) discontinuation versus NA continuation has not been performed in patients with chronic hepatitis B who achieved HBsAg-seroclearance. Whether NA discontinuation was as safe as NA continuation after NA-induced surface antigen of HBV (HBsAg) seroclearance was investigated in the present study. Designs: This multicentre study included 276 patients from 16 hospitals in Korea who achieved NA-induced HBsAg seroclearance: 131 (47.5%) discontinued NA treatment within 6 months after HBsAg seroclearance (NA discontinuation group) and 145 (52.5%) continued NA treatment (NA continuation group). Primary endpoint was HBsAg reversion and secondary endpoints included serum HBV DNA redetection and development of hepatocellular carcinoma (HCC). Results: During follow-up (median=26.9 months, IQR=12.2–49.2 months), 10 patients (3.6%) experienced HBsAg reversion, 6 (2.2%) showed HBV DNA redetection and 8 (2.9%) developed HCC. Compared with NA continuation, NA discontinuation was not associated with HBsAg reversion in both univariable (HR=0.45, 95% CI=0.12 to 1.76, log-rank p=0.24) and multivariable analyses (adjusted HR=0.65, 95% CI=0.16 to 2.59, p=0.54). The cumulative probabilities of HBsAg reversion at 1, 3 and 5 years were 0.8%, 2.3% and 5.0% in the NA discontinuation group, and 1.5%, 6.3% and 8.4% in the NA continuation group, respectively. NA discontinuation was not associated with higher risk of either HBV redetection (HR=0.83, 95% CI=0.16 to 4.16, log-rank p=0.82) or HCC development (HR=0.53, 95% CI=0.12 to 2.23, log-rank p=0.38). Conclusion: The discontinuation of NA was not associated with a higher risk of either HBsAg reversion, serum HBV DNA redetection or HCC development compared with NA continuation among patients who achieved HBsAg seroclearance with NA.