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Post-treatment HBsAg decline predicts high rate of HBsAg loss after stopping entecavir or tenofovir in HBeAg-negative patients without retreatment

  • Hsin-Wei Fang
    Affiliations
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC
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  • Tsung-Hui Hu
    Affiliations
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC
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  • Jing-Houng Wang
    Affiliations
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC
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  • Chao-Hung Hung
    Affiliations
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC
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  • Sheng-Nan Lu
    Affiliations
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC
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  • Chien-Hung Chen
    Correspondence
    Corresponding author.
    Affiliations
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC
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Published:March 02, 2023DOI:https://doi.org/10.1016/j.dld.2023.02.006

      Abstract

      Background/Aims

      Little is known about the role of post-treatment HBsAg decline in HBsAg loss following nucleos(t)ide analogues cessation.

      Methods

      HBeAg-negative patients without cirrhosis who previously received entecavir or tenofovir disoproxil fumarate (TDF) were enrolled (n=530). All patients were followed-up post-treatment for >24 months.

      Results

      Of the 530 patients, 126 achieved sustained response (Group I), 85 experienced virological relapse without clinical relapse and retreatment (Group II), 67 suffered clinical relapse without retreatment (Group III) and 252 received retreatment (Group IV). The cumulative incidence of HBsAg loss at 8 years was 57.3% in Group I, 24.1% in Group II, 35.9% in Group III and 7.3% in Group IV. Cox regression analysis showed that nucleos(t)ide analogue experience, lower HBsAg levels at end-of-treatment (EOT) and higher HBsAg decline at 6 months after EOT were independently associated with HBsAg loss in Group I and Groups II+III. The rates of HBsAg loss at 6 years in patients with HBsAg decline >0.2 log IU/mL in Group I and HBsAg decline >0.15 log IU/mL in Group II+III at 6 months after EOT were 87.7% and 47.1%, respectively.

      Conclusion

      The HBsAg loss rate was high and post-treatment HBsAg decline could predict high HBsAg loss rate among HBeAg-negative patients who discontinued entecavir or TDF and did not need retreatment.

      Keywords

      Abbreviations:

      ALT (alanine aminotransferase), CHB (chronic hepatitis B), HBV (hepatitis B virus), HBcrAg (hepatitis B core related antigen), HBeAg (hepatitis B e antigen), HBsAg (hepatitis B surface antigen), NA (nucleoside analogue), EOT (end-of-treatment), TDF (tenofovir disoproxil fumarate), ULN (upper limit of normal), ROC (receiver-operating characteristic)
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