Stopping nucleos(t)ide analogue treatment in Caucasian hepatitis B patients after HBeAg seroconversion is associated with high relapse rates and fatal outcomes

Autor: Van Hees, S., Bourgeois, S., Van Vlierberghe, H., Sersté, T., Francque, S., Michielsen, P., Sprengers, D., Reynaert, H., Henrion, J., Negrin Dastis, S., Delwaide, J., Lasser, L., Decaestecker, J., Orlent, H., Janssens, F., Robaeys, G., Colle, I., Stärkel, P., Moreno, C., Nevens, F., Vanwolleghem, T., Van Hees, Stijn, Bourgeois, Stefan, Van Vlierberghe, Hans, Sersté, Thomas, Francque, Sven, Michielsen, Peter, Sprengers, Dirk, Reynaert, Hendrik, Henrion, Jean, Negrin‐Dastis, Sergio, Delwaide, Jean, Lasser, Luc, Decaestecker, Jochen, Orlent, Hans, Janssens, Filip, Robaeys, Geert, Colle, Isabelle, Stärkel, Peter, Moreno, Christophe, Nevens, Frederik, Vanwolleghem, Thomas
Přispěvatelé: Nuclear Medicine, Liver Cell Biology, Laboratory of Molecullar and Cellular Therapy, Basic (bio-) Medical Sciences, Faculty of Medicine and Pharmacy, Gastroenterology, Gastroenterology & Hepatology, Belgian NA Stop Study Group
Rok vydání: 2018
Předmět:
Male
0301 basic medicine
HBsAg
Antibodies
Viral
Gastroenterology
Cohort Studies
Fatal Outcome
0302 clinical medicine
Recurrence
HEPATOCELLULAR-CARCINOMA
E-ANTIGEN
Medicine and Health Sciences
Pharmacology (medical)
Hepatitis B e Antigens
ENTECAVIR TREATMENT
Pharmacology. Therapy
Nucleosides
Middle Aged
Hepatitis B
PREDICTS
Treatment Outcome
HBeAg
Seroconversion
Hepatocellular carcinoma
SUSTAINED VIROLOGICAL RESPONSE
Cohort
Original Article
Female
030211 gastroenterology & hepatology
CLINICAL-PRACTICE GUIDELINES
Cohort study
Adult
Hepatitis B virus
medicine.medical_specialty
DISCONTINUATION
VIRUS-INFECTION
GAMMA-GLUTAMYL-TRANSFERASE
Antiviral Agents
03 medical and health sciences
Hepatitis B
Chronic
SDG 3 - Good Health and Well-being
Fatal Outcomes from Stopping Nucleoside Analogues in Hepatitis B
Internal medicine
SEROCONVERSION
medicine
Humans
CONSOLIDATION THERAPY
Hepatology
business.industry
medicine.disease
digestive system diseases
Discontinuation
030104 developmental biology
Withholding Treatment
Human medicine
business
Zdroj: Alimentary Pharmacology & Therapeutics, 47(8), 1170-1180. Wiley-Blackwell Publishing Ltd
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
Alimentary Pharmacology & Therapeutics
Alimentary pharmacology and therapeutics
ISSN: 0269-2813
1365-2036
DOI: 10.1111/apt.14560
Popis: Background: Stopping nucleos(t)ide analogues (NA) after hepatitis B e antigen (HBeAg) seroconversion is associated with high relapse rates in Asian patients, but data in Caucasian cohorts are scarce. Clinical course, outcomes and immunological aspects of chronic hepatitis B infections differ substantially between distinct ethnicities. Aim: The aim of this study was to determine relapse rates, factors predicting relapse and clinical outcomes after nucleos(t)ide analogue cessation in a large, predominantly Caucasian cohort of chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroconversion. Methods: This is a nationwide observational cohort study including HBeAg positive, mono-infected chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroconversion from 18 centres in Belgium. Results: A total of 98 patients with nucleo(s)tide analogue-induced HBeAg seroconversion were included in the study. Of the 62 patients who stopped treatment after a median consolidation treatment of 8 months, 30 relapsed. Higher gamma-glutamyl transferase levels at both treatment initiation (HR 1.004; P = 0.001 per unit increment) and HBeAg seroconversion (HR 1.006; P = 0.013 per unit increment) were associated with an increased risk of clinically significant relapse in a multivariate Cox regression model. Treatment cessation led to liver-related death in 2 patients, of whom one showed a severe flare. Of the patients who continued treatment after HBeAg seroconversion, none relapsed or developed severe hepatic outcomes. Conclusion: Treatment withdrawal in Caucasian chronic hepatitis B patients after nucleos(t)ide analogue-induced HBeAg seroconversion results in viral relapses in more than half of patients with potential fatal outcomes. These real-world data further lend support to preferentially continue NA treatment after HBeAg seroconversion until HBsAg loss. Foundation Against Cancer Belgium, Grant/Award Number: 2014-087
Databáze: OpenAIRE
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