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Article: Role of serum HBV RNA and hepatitis B surface antigen levels in identifying Asian patients with chronic hepatitis B suitable for entecavir cessation

TitleRole of serum HBV RNA and hepatitis B surface antigen levels in identifying Asian patients with chronic hepatitis B suitable for entecavir cessation
Authors
Issue Date2020
PublisherBMJ Publishing Group. The Journal's web site is located at http://gut.bmjjournals.com/
Citation
Gut, 2020, Epub 2020-08-05 How to Cite?
AbstractBackground: Treatment cessation in chronic HBV infection may be durable in certain patient subgroups before hepatitis B surface antigen (HBsAg) seroclearance. The role of serum HBV RNA in determining treatment cessation suitability has not been well-investigated. Methods: Nucleos(t)ide analogue (NUC) treatment was discontinued in non-cirrhotic patients with chronic HBV with serum HBsAg <200 IU/mL and fulfilling internationally recommended criteria for treatment cessation. Patients were monitored till 48 weeks with baseline and serial measurements of serum HBsAg, HBV RNA and hepatitis B core-related antigen. NUCs were resumed when HBV DNA reaches >2000 IU/mL regardless of alanine aminotransferase (ALT) levels. Results: 114 entecavir-treated patients (median age 58.4 years, median serum HBsAg 54.4 IU/mL) with median treatment duration of 6.7 years were recruited. The 48-week cumulative rate of HBV DNA >2000 IU/mL was 58.1%. End-of-treatment serum HBV RNA and off-treatment serial HBV RNA were both independently associated with HBV DNA >2000 IU/mL (HR 2.959, 95% CI 1.776 to 4.926, p<0.001; HR 2.278, 95% CI 1.151 to 4.525, p=0.018, respectively). Patients with HBV RNA ≥44.6 U/mL had a cumulative 48-week rate of 93.2%, while combining HBV RNA undetectability and HBsAg <10 IU/mL had a cumulative 48-week rate of 9.1%. 24 patients (38.7%) developed off-treatment ALT elevation, highest peak ALT was 1515 U/L. 8 patients (median serum HBsAg 2.6 IU/mL) developed HBsAg seroclearance. Conclusion: Serum HBV RNA measurement is essential for deciding on entecavir cessation in patients with chronic HBV, especially with low HBsAg levels. Patients can be stratified on their risk of off-treatment relapse based on both viral determinants. Trial registration number: NCT02738554
Persistent Identifierhttp://hdl.handle.net/10722/284585
ISSN
2019 Impact Factor: 19.819
2015 SCImago Journal Rankings: 6.474

 

DC FieldValueLanguage
dc.contributor.authorSeto, WK-
dc.contributor.authorLiu, KSH-
dc.contributor.authorMak, LY-
dc.contributor.authorCloherty, G-
dc.contributor.authorWong, DKH-
dc.contributor.authorGersch, J-
dc.contributor.authorLam, YF-
dc.contributor.authorCheung, KS-
dc.contributor.authorChow, N-
dc.contributor.authorKo, KL-
dc.contributor.authorTo, WP-
dc.contributor.authorFung, J-
dc.contributor.authorYuen, MF-
dc.date.accessioned2020-08-07T08:59:44Z-
dc.date.available2020-08-07T08:59:44Z-
dc.date.issued2020-
dc.identifier.citationGut, 2020, Epub 2020-08-05-
dc.identifier.issn0017-5749-
dc.identifier.urihttp://hdl.handle.net/10722/284585-
dc.description.abstractBackground: Treatment cessation in chronic HBV infection may be durable in certain patient subgroups before hepatitis B surface antigen (HBsAg) seroclearance. The role of serum HBV RNA in determining treatment cessation suitability has not been well-investigated. Methods: Nucleos(t)ide analogue (NUC) treatment was discontinued in non-cirrhotic patients with chronic HBV with serum HBsAg <200 IU/mL and fulfilling internationally recommended criteria for treatment cessation. Patients were monitored till 48 weeks with baseline and serial measurements of serum HBsAg, HBV RNA and hepatitis B core-related antigen. NUCs were resumed when HBV DNA reaches >2000 IU/mL regardless of alanine aminotransferase (ALT) levels. Results: 114 entecavir-treated patients (median age 58.4 years, median serum HBsAg 54.4 IU/mL) with median treatment duration of 6.7 years were recruited. The 48-week cumulative rate of HBV DNA >2000 IU/mL was 58.1%. End-of-treatment serum HBV RNA and off-treatment serial HBV RNA were both independently associated with HBV DNA >2000 IU/mL (HR 2.959, 95% CI 1.776 to 4.926, p<0.001; HR 2.278, 95% CI 1.151 to 4.525, p=0.018, respectively). Patients with HBV RNA ≥44.6 U/mL had a cumulative 48-week rate of 93.2%, while combining HBV RNA undetectability and HBsAg <10 IU/mL had a cumulative 48-week rate of 9.1%. 24 patients (38.7%) developed off-treatment ALT elevation, highest peak ALT was 1515 U/L. 8 patients (median serum HBsAg 2.6 IU/mL) developed HBsAg seroclearance. Conclusion: Serum HBV RNA measurement is essential for deciding on entecavir cessation in patients with chronic HBV, especially with low HBsAg levels. Patients can be stratified on their risk of off-treatment relapse based on both viral determinants. Trial registration number: NCT02738554-
dc.languageeng-
dc.publisherBMJ Publishing Group. The Journal's web site is located at http://gut.bmjjournals.com/-
dc.relation.ispartofGut-
dc.rightsGut. Copyright © BMJ Publishing Group.-
dc.rightsThis article has been accepted for publication in [Journal, Year] following peer review, and the Version of Record can be accessed online at [insert full DOI eg. http://dx.doi.org/10.1136/xxxxx]. [© Authors (or their employer(s)) OR © BMJ Publishing Group Ltd ( for assignments of BMJ Case Reports)] <year>-
dc.titleRole of serum HBV RNA and hepatitis B surface antigen levels in identifying Asian patients with chronic hepatitis B suitable for entecavir cessation-
dc.typeArticle-
dc.identifier.emailSeto, WK: wkseto@hku.hk-
dc.identifier.emailLiu, KSH: drkliu@hku.hk-
dc.identifier.emailMak, LY: lungyi@hku.hk-
dc.identifier.emailWong, DKH: danywong@hku.hk-
dc.identifier.emailLam, YF: fyflam@hku.hk-
dc.identifier.emailCheung, KS: cks634@hku.hk-
dc.identifier.emailFung, J: jfung@HKUCC-COM.hku.hk-
dc.identifier.emailYuen, MF: mfyuen@hku.hk-
dc.identifier.authoritySeto, WK=rp01659-
dc.identifier.authorityMak, LY=rp02668-
dc.identifier.authorityWong, DKH=rp00492-
dc.identifier.authorityLam, YF=rp02564-
dc.identifier.authorityCheung, KS=rp02532-
dc.identifier.authorityFung, J=rp00518-
dc.identifier.authorityYuen, MF=rp00479-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1136/gutjnl-2020-321116-
dc.identifier.pmid32759300-
dc.identifier.hkuros312610-
dc.identifier.volumeEpub 2020-08-05-
dc.publisher.placeUnited Kingdom-

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