Sistema de Salut de Catalunya
Institut Català de la Salut
[Sonneveld MJ, Brakenhoff SM] Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. [Chiu SM] Department of Internal Medicine, Koahsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. [Park JY] Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. [Kaewdech A] Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand. [Seto WK] Department of Medicine, State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong. [Buti M] Unitat del Fetge, Servei de Medicina Interna, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Ciberehd del Intituto Carlos III de Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2022-09-12T08:18:44Z
2022-09-12T08:18:44Z
2022-05
HBV genotype; Viral antigen
Genotipo VHB; Antígeno viral
Genotip del VHB; Antigen viral
Background & Aims Nucleo(s)tide analogue (NUC) withdrawal may result in HBsAg clearance in a subset of patients. However, predictors of HBsAg loss after NUC withdrawal remain ill-defined. Methods We studied predictors of HBsAg loss in a global cohort of HBeAg-negative patients with undetectable HBV DNA who discontinued long-term NUC therapy. Patients requiring retreatment after treatment cessation were considered non-responders. Results We enrolled 1,216 patients (991 with genotype data); 98 (8.1%) achieved HBsAg loss. The probability of HBsAg loss was higher in non-Asian patients (adjusted hazard ratio [aHR] 8.26, p <0.001), and in patients with lower HBsAg (aHR 0.243, p <0.001) and HBV core-related antigen (HBcrAg) (aHR 0.718, p = 0.001) levels. Combining HBsAg (<10, 10-100 or >100 IU/ml) and HBcrAg (<2log vs. ≥2 log) levels improved prediction of HBsAg loss, with extremely low rates observed in patients with HBsAg >100 IU/ml with detectable HBcrAg. HBsAg loss rates also varied with HBV genotype; the highest rates were observed for genotypes A and D, and none of the patients with HBV genotype E experienced HBsAg loss (p <0.001 for the overall comparison across genotypes; p <0.001 for genotypes A/D vs. genotypes B/C). HBV genotype C was independently associated with a higher probability of HBsAg loss when compared to genotype B among Asian patients (aHR 2.494; 95% CI 1.490–4.174, p = 0.001). Conclusions The probability of HBsAg loss after NUC cessation varies according to patient ethnicity, HBV genotype and end-of-treatment viral antigen levels. Patients with low HBsAg (<100 IU/ml) and/or undetectable HBcrAg levels, particularly if non-Asian or infected with HBV genotype C, appear to be the best candidates for treatment withdrawal.
The CREATE study was supported by Fujirebio. No additional funding was obtained for this follow-up analysis.
Article
Published version
English
Medicaments antivírics - Ús terapèutic; Hepatitis B - Tractament; CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiviral Agents; Other subheadings::Other subheadings::/therapeutic use; DISEASES::Virus Diseases::DNA Virus Infections::Hepadnaviridae Infections::Hepatitis B::Hepatitis B, Chronic; COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antivíricos; Otros calificadores::Otros calificadores::/uso terapéutico; ENFERMEDADES::virosis::infecciones por virus ADN::infecciones por Hepadnaviridae::hepatitis B::hepatitis B crónica
Elsevier
Journal of Hepatology;76(5)
https://doi.org/10.1016/j.jhep.2022.01.007
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - HVH [3440]
