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Conference Paper: Treatment Cessation in Chronic Hepatitis B: Predicting Off-Treatment Durability Via Combination of Viral Markers

TitleTreatment Cessation in Chronic Hepatitis B: Predicting Off-Treatment Durability Via Combination of Viral Markers
Authors
Issue Date2018
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/
Citation
The Liver Meeting 2018, American Association for the Study of Liver Diseases (AASLD), San Francisco, USA, 9-13 November 2018. Abstracts in Hepatology, 2018, v. 68 n. Suppl. 1, p. 248A-249A How to Cite?
AbstractBackground: Treatment cessation in nucleoside analoguetreated chronic hepatitis B (CHB) can be associated with high rates of disease relapse. Serum hepatitis B surface antigen (HBsAg) levels have been suggested as a marker reflecting immune control. We investigated the efficacy of treatment cessation and predictors of successful off-treatment durability in CHB patients with low serum HBsAg levels. Methods: We prospectively recruited consecutive non-cirrhotic HBsAgpositive patients treated with entecavir or tenofovir with serum HBsAg <200 IU/mL and fulfilling the European Association for the Study of the Liver (EASL) criteria for treatment cessation. Liver biochemistry, serum HBV DNA, HBsAg and hepatitis B core-related antigen (HBcrAg) were measured at baseline and every 6 weeks up to week 48 after treatment cessation. HBV reactivation was defined as HBV DNA >2,000 IU/mL. Treatment was re-initiated in patients with HBV reactivation and elevated alanine aminotransferase (ALT) (>40 U/L), or with two consecutive HBV DNA readings of >2,000 IU/mL (the second measurement taken within two weeks). Results: In this interim analysis, 103 patients (mean age 56.4 ±10.9 years, 67.0% male) with a mean nucleoside analogue treatment duration of 7.1 (±2.0) years were recruited. Median duration of follow-up after treatment cessation was 42 (IQR 29-48) weeks. Median baseline HBsAg and HBcrAg levels were 55.3 (16.9-89.5) IU/mL and 1.1 (0.3-4.7) kU/mL respectively. The cumulative rate of HBV reactivation at 48 weeks, calculated by the Kaplan-Meier method, was 59.2%. Among 78 patients with available viral measurements, baseline serum HBsAg ≤10 IUmL, compared to HBsAg >10 IU/mL, had a significantly lower cumulative rate of HBV reactivation (31.6% versus 66.1%, p=0.023). A lower baseline serum HBsAg level, via Cox regression, was associated with significantly lower rates of HBV reactivation (p=0.047, OR 1.005, 95%CI 1.001-1.010). A lower baseline serum HBcrAg level was associated with lower HBV reactivation rates in patients with baseline serum HBsAg >20 IU/mL (p=0.020, OR 1.034, 95%CI 1.005-1.063) but not among all patients (p=0.147). 16 (33.3%) patients with HBV reactivation developed ALT elevation (median ALT 104 U/L, IQR 62-151 U/L). All HBV reactivation cases were eventually controlled with either entecavir or tenofovir. Conclusion: HBV reactivation remained common after treatment cessation in HBsAg-positive patients with low HBsAg levels. Combining serum HBsAg and HBcrAg kinetics can identify patients with likely off-treatment durability after treatment discontinuation. (Clinicaltrials.gov identifier NCT02738554)
DescriptionPoster Presentation - no. 417
Persistent Identifierhttp://hdl.handle.net/10722/269507
ISSN
2019 Impact Factor: 14.679
2015 SCImago Journal Rankings: 4.752
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSeto, WKW-
dc.contributor.authorLiu, SHK-
dc.contributor.authorMak, LY-
dc.contributor.authorCheung, KSM-
dc.contributor.authorWong, DKH-
dc.contributor.authorLiu, F-
dc.contributor.authorFung, JYY-
dc.contributor.authorLai, CL-
dc.contributor.authorYuen, RMF-
dc.date.accessioned2019-04-24T08:09:05Z-
dc.date.available2019-04-24T08:09:05Z-
dc.date.issued2018-
dc.identifier.citationThe Liver Meeting 2018, American Association for the Study of Liver Diseases (AASLD), San Francisco, USA, 9-13 November 2018. Abstracts in Hepatology, 2018, v. 68 n. Suppl. 1, p. 248A-249A-
dc.identifier.issn0270-9139-
dc.identifier.urihttp://hdl.handle.net/10722/269507-
dc.descriptionPoster Presentation - no. 417-
dc.description.abstractBackground: Treatment cessation in nucleoside analoguetreated chronic hepatitis B (CHB) can be associated with high rates of disease relapse. Serum hepatitis B surface antigen (HBsAg) levels have been suggested as a marker reflecting immune control. We investigated the efficacy of treatment cessation and predictors of successful off-treatment durability in CHB patients with low serum HBsAg levels. Methods: We prospectively recruited consecutive non-cirrhotic HBsAgpositive patients treated with entecavir or tenofovir with serum HBsAg <200 IU/mL and fulfilling the European Association for the Study of the Liver (EASL) criteria for treatment cessation. Liver biochemistry, serum HBV DNA, HBsAg and hepatitis B core-related antigen (HBcrAg) were measured at baseline and every 6 weeks up to week 48 after treatment cessation. HBV reactivation was defined as HBV DNA >2,000 IU/mL. Treatment was re-initiated in patients with HBV reactivation and elevated alanine aminotransferase (ALT) (>40 U/L), or with two consecutive HBV DNA readings of >2,000 IU/mL (the second measurement taken within two weeks). Results: In this interim analysis, 103 patients (mean age 56.4 ±10.9 years, 67.0% male) with a mean nucleoside analogue treatment duration of 7.1 (±2.0) years were recruited. Median duration of follow-up after treatment cessation was 42 (IQR 29-48) weeks. Median baseline HBsAg and HBcrAg levels were 55.3 (16.9-89.5) IU/mL and 1.1 (0.3-4.7) kU/mL respectively. The cumulative rate of HBV reactivation at 48 weeks, calculated by the Kaplan-Meier method, was 59.2%. Among 78 patients with available viral measurements, baseline serum HBsAg ≤10 IUmL, compared to HBsAg >10 IU/mL, had a significantly lower cumulative rate of HBV reactivation (31.6% versus 66.1%, p=0.023). A lower baseline serum HBsAg level, via Cox regression, was associated with significantly lower rates of HBV reactivation (p=0.047, OR 1.005, 95%CI 1.001-1.010). A lower baseline serum HBcrAg level was associated with lower HBV reactivation rates in patients with baseline serum HBsAg >20 IU/mL (p=0.020, OR 1.034, 95%CI 1.005-1.063) but not among all patients (p=0.147). 16 (33.3%) patients with HBV reactivation developed ALT elevation (median ALT 104 U/L, IQR 62-151 U/L). All HBV reactivation cases were eventually controlled with either entecavir or tenofovir. Conclusion: HBV reactivation remained common after treatment cessation in HBsAg-positive patients with low HBsAg levels. Combining serum HBsAg and HBcrAg kinetics can identify patients with likely off-treatment durability after treatment discontinuation. (Clinicaltrials.gov identifier NCT02738554)-
dc.languageeng-
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/-
dc.relation.ispartofHepatology-
dc.relation.ispartofAmerican Association for the Study of Liver Diseases (AASLD): The Liver Meeting 2018-
dc.titleTreatment Cessation in Chronic Hepatitis B: Predicting Off-Treatment Durability Via Combination of Viral Markers-
dc.typeConference_Paper-
dc.identifier.emailSeto, WKW: wkseto@hku.hk-
dc.identifier.emailLiu, SHK: drkliu@hku.hk-
dc.identifier.emailCheung, KSM: cks634@hku.hk-
dc.identifier.emailWong, DKH: danywong@hku.hk-
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hk-
dc.identifier.emailLai, CL: hrmelcl@hkucc.hku.hk-
dc.identifier.emailYuen, RMF: mfyuen@hku.hk-
dc.identifier.authoritySeto, WKW=rp01659-
dc.identifier.authorityCheung, KSM=rp02532-
dc.identifier.authorityWong, DKH=rp00492-
dc.identifier.authorityFung, JYY=rp00518-
dc.identifier.authorityLai, CL=rp00314-
dc.identifier.authorityYuen, RMF=rp00479-
dc.identifier.hkuros297383-
dc.identifier.volume68-
dc.identifier.issueSuppl. 1-
dc.identifier.spage248A-
dc.identifier.epage249A-
dc.identifier.isiWOS:000446020500420-
dc.publisher.placeUnited States-

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