This article is more than 5 years old. Information may no longer be current.

Lasting virological remission post-discontinuation of HBV therapy may be possible

In a systematic review, researchers found that patients who discontinued long-term nucleos(t)ide analogue therapy for chronic hepatitis B virus infection were still capable of maintaining virological remission, according to published findings.

“The need for long-term [nucleos(t)ide analogue] therapy raises safety issues for some patients … and family planning issues in patients of reproductive age along with increases in treatment costs. Many physicians treating [patients with chronic HBV] with [nucleos(t)ide analogue] for years have become interested in investigating the need for continuation as well as the safety of therapy withdrawal. … Limitation of long-term duration of [nucleos(t)ide analogue] therapy seems to be one of the major aims nowadays,” George Papatheodoridis, MD, director, department of gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, Greece, and colleagues wrote.

George Papatheodoridis

Researchers analyzed data of 1,716 patients with chronic HBV from 25 studies from 2002 to 2014, who discontinued nucleos(t)ide analogue (NA) treatment. The goal was to determine factors that affect the probability of post-treatment remission, according to the research.

Overall, pooled rates of lasting virological remission were 51.4% at 1 year, 39.3% at 2 years and 38.2% at 3 years after NA discontinuation. These rates were higher in patients initially positive for hepatitis B e antigen (HBeAg; 62.5%, 53.4%, 51.5%) compared with patients who were HBeAg-negative (43.7%, 31.3%, 30.1%; P = .064).

The weighted probability of lasting biochemical HBV remission was 65.4%. This was also higher in patients who were HBeAg-positive (76.2%) compared with patients who were HBeAg-negative (56.7%, P = .13).

The weighted probability of lasting HBeAg seroconversion was 91.9% at 1 year and 88% at 2 years after NA discontinuation. This was not affected by the duration of on-therapy virological remission or consolidation therapy, which was greater than 6 months in all of the studies.

The weighted probability of hepatitis B surface antigen loss was 2%.

The rates of lasting virological remission were not different based on varying definitions of virological remission or duration of on-therapy virological remission in patients who were HBeAg-positive. However, the rate of virological remission 1 year after NA discontinuation was 75% in studies that had on-therapy virological remission durations of greater than 2 years and 35.6% in studies that had on-therapy virological remission durations of less than 2 years (P = .005).

The researchers concluded: “Discontinuation of long-term NA therapy may be attempted if close follow-up can be guaranteed in patients without advanced liver disease.” – by Melinda Stevens

Disclosure: Papatheodoridis reports consulting, advising and speaking for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, MSD and Roche; has received grants from AbbVie, Bristol-Myers Squibb, Gilead Sciences and Roche; and is an advisor and speaker for Novartis. Please see the full study for a list of all other authors’ relevant financial disclosures.