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Incidence and predictors of retreatment in chronic hepatitis B patients after discontinuation of entecavir or tenofovir treatment


Autoři: Te-Ling Ma aff001;  Tsung-Hui Hu aff001;  Chao-Hung Hung aff001;  Jing-Houng Wang aff001;  Sheng-Nan Lu aff001;  Chien-Hung Chen aff001
Působiště autorů: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222221

Souhrn

Background

This study investigated the incidence and predictors of retreatment after discontinuation of either entecavir (ETV) or tenofovir disoproxil fumarate (TDF) treatment in Taiwan.

Methods

A total of 535 non-cirrhotic chronic hepatitis B (CHB) patients undergoing either ETV (n = 358) or TDF (n = 177) treatment were enrolled. Patients were followed for at least 12 months after stopping ETV or TDF treatment. Most patients (86.3%) fulfilled the retreatment criteria of Taiwan's National Health Plan.

Results

The 5-year cumulative rates of clinical relapse and retreatment were 52.1% and 47%, respectively, in 160 hepatitis B e antigen (HBeAg)-positive patients, and were 62% and 54.8%, respectively, in 375 HBeAg-negative patients. The median duration from the end of treatment until clinical relapse and retreatment was 40 and 57 weeks, respectively, for all patients. Multivariate Cox regression analysis revealed that discontinuing TDF treatment, old age, male gender, and higher baseline HBsAg levels were independent factors of retreatment in HBeAg-positive patients; old age, HBV genotype B, and higher baseline and end-of-treatment HBsAg levels were independent factors in HBeAg-negative patients. A total of 18.8% of retreated patients satisfied the retreatment criteria of hepatic decompensation according to Taiwan's National Health Plan. Of the 64 patients who had clinical relapse without retreatment, 17 achieved sustained virological remission and 26 did not experience clinical relapse until their last visit after clinical relapse. Four patients developed HBsAg loss.

Conclusions

The 5-year retreatment rate was about 50% in HBeAg-positive and HBeAg-negative patients. Discontinuing TDF treatment was an independent factor of retreatment in HBeAg-positive patients.

Klíčová slova:

Alanine – bilirubin – Cirrhosis – Hepatitis B – Hepatitis B virus – Regression analysis – Taiwan


Zdroje

1. Weinbaum CM, Mast EE, Ward JW. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Hepatology 2009;49:535–544.

2. Liaw YF, Chu CM. Hepatitis B virus infection. Lancet 2009;373:582–592. doi: 10.1016/S0140-6736(09)60207-5 19217993

3. Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1–98.

4. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017;67:370–398. doi: 10.1016/j.jhep.2017.03.021 28427875

5. Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63:261–283. doi: 10.1002/hep.28156 26566064

6. Chen CH, Hung CH, Hu TH, Wang JH, Lu SN, Su PF, et al. Association between level of hepatitis B surface antigen and relapse after entecavir therapy for chronic HBV infection. Clin Gastroenterol Hepatol 2015;13:1984–1992. doi: 10.1016/j.cgh.2015.06.002 26073492

7. Jeng WJ, Chen YC, Sheen IS, Lin CL, Hu TH, Chien RN, et al. Clinical relapse after cessation of tenofovir therapy in hepatitis B e antigen-negative patients. Clin Gastroenterol Hepatol 2016;14:1813–1820. doi: 10.1016/j.cgh.2016.07.002 27404969

8. Jeng WJ, Sheen IS, Chen YC, Hsu CW, Chien RN, Chu CM, et al. Off-therapy durability of response to entecavir therapy in hepatitis B e antigen-negative chronic hepatitis B patients. Hepatology 2013;58:1888–1896. doi: 10.1002/hep.26549 23744454

9. Chen CH, Hsu YC, Lu SN, Hung CH, Wang JH, Lee CM, et al. The incidence and predictors of HBV relapse after cessation of tenofovir therapy in chronic hepatitis B patients. J Viral Hepat 2018;25:590–597. doi: 10.1111/jvh.12851 29274189

10. Chen CH, Hung CH, Wang JH, Lu SN, Hu TH, Lee CM. Long-term incidence and predictors of hepatitis B surface antigen loss after discontinuing nucleoside analogues in noncirrhotic chronic hepatitis B patients. Clin Microbiol Infect 2018;24:997–1003. doi: 10.1016/j.cmi.2017.12.013 29288020

11. Kuo MT, Hu TH, Hung CH, Wang JH, Sheng-Nan Lu SN, Tsai KL, et al. Comparison of hepatitis B virus relapse rates between chronic hepatitis B patients who discontinue entecavir and tenofovir treatment. Aliment Pharmacol Ther 2019;49:218–228. doi: 10.1111/apt.15053 30484881

12. Su TH, Yang HC, Tseng TC, Liu CJ, Kao JH. Distinct relapse rates and risk predictors after Discontinuing tenofovir and entecavir therapy. J Infect Dis 2018;21:1193–1201.

13. Jeng WJ, Chen YC, Chien RN, Sheen IS, Liaw YF. Incidence and predictors of hepatitis B surface antigen seroclearance after cessation of nucleos(t)ide analogue therapy in hepatitis B e antigen-negative chronic hepatitis B. Hepatology 2018;68:425–434. doi: 10.1002/hep.29640 29108132

14. Liaw YF, Kao JH, Piratvisuth T, Chan HL, Chien RN, Liu CJ, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int 2012;6:531–561. doi: 10.1007/s12072-012-9365-4 26201469

15. Lee CM, Chen CH, Lu SN, Tung HD, Chou WJ, Wang JH, et al. Prevalence and clinical implications of hepatitis B virus genotypes in southern Taiwan. Scand J Gastroenterol 2003;38:95–101. doi: 10.1080/00365520310000500 12608471

16. Heagerty PJ, Lumley T, Pepe MS. Time-dependent ROC curves for censored survival data and a diagnostic marker. Biometrics 2000;56:337–344. 10877287

17. Xu WX, Zhang Q, Zhu X, Lin CS, Chen YM, Deng H1, et al. 48-Week outcome after cessation of nucleos(t)ide analogue treatment in chronic hepatitis B patient and the associated factors with relapse. Can J Gastroenterol Hepatol 2018 May 10;2018:1817680. doi: 10.1155/2018/1817680 29862225

18. Papatheodoridis GV, Rigopoulou EI, Papatheodoridi M, Zachou K, Xourafas V, Gatselis N, et al. DARING-B: discontinuation of effective entecavir or tenofovir disoproxil fumarate long-term therapy before HBsAg loss in non-cirrhotic HBeAg-negative chronic hepatitis B. Antivir Ther 2018, in press.

19. Papatheodoridis GV, Manolakopoulos S, Su TH, Siakavellas S, Liu CJ, Kourikou A, et al. Significance of definitions of relapse after discontinuation of oral antivirals in HBeAg-negative chronic hepatitis B. Hepatology 2018;68:415–424. doi: 10.1002/hep.29497 28859219

20. Liaw YF, Jeng WJ, Chang ML. HBsAg kinetics in retreatment decision for off-therapy hepatitis B flare in HBeAg-negative patients. Gastroenterology. 2018;154:2280–2281. doi: 10.1053/j.gastro.2018.03.066 29746811


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