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Off therapy durability of response
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Liver Research Unit, Linkou Medical Center, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University.

Abstract

The optimal duration of nucelos(t)ide analoge (Nuc) treatment in hepatitis B e antigen (HBeAg) negative patients with chronic hepatitis B virus (HBV) infection is unknown. Asian Pacific Association for the Study of the Liver (APASL) guidelines recommend that treatment can be discontinued if undetectable HBV-DNA has been documented on three occasions ? 6 months apart. This study aimed to test this stopping rule in HBeAg-negative chronic hepatitis B (CHB) patients treated with Entecavir (ETV). Ninety-five patients (39 cirrhotics) were treated with ETV for a median of 721 (395-1762) days before stopping therapy and were then monitored with serum HBV DNA and alanine aminotransferase (ALT) at least every 3 months. Within 1-year after stopping ETV therapy, "clinical relapse" (an episode of ALT elevation >2× upper limit of normal plus HBV- DNA>2000IU/mL) occurred in 43 (45.3%) of the 95 patients. Of the 39 cirrhotic patients, 17 (43.6%) relapsed and one (2.6%) developed decompensation. The median duration till relapse was 230 days (74.4% > 6 months). Logistic regression analysis showed that baseline HBV-DNA ?2×10^5 IU/mL was the only significant independent factor for sustained response. The 1-year relapse rate was 29% in patients with a baseline HBV DNA ?2×10^5 IU/mL vs 53% in those with HBV DNA >2×10^5 IU/mL (p=0.027). For the later, consolidation therapy > 64 weeks reduced relapse rate to 33.3% in non-cirrhotic patients. Conclusion: With an overall 1-year relapse rate of 45% and 29% in those with a baseline serum HBV DNA ?2×10^5 IU/mL, the APASL stopping rule for HBeAg-negative CHB patients with proper off-therapy monitoring is adequate even in cirrhotic patients. Consolidation therapy > 64 weeks seems more appropriate for those with higher baseline HBV DNA. (HEPATOLOGY 2013.).
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http://www.ncbi.nlm.nih.gov/pubmed/23744454
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i think there are countries running out of money........

to stop antivirals on cirrhotic patients you need at least cirrhosis regression to stay safe because hbvdna und in blood is not a good test to reflect what is going on in the liver
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I don't know is this is elated to running out of money.

judging from this abstract, it can be say that more people will start NUC's and stop after a period of time, so some how the money will increase in the immediate period.

anyway, all this are only supposition, but I consider the the good news is the no mutation was reported .....
  
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news is the no mutation was reported .....

resistance is the right word, mutations accumulate anyway all the time.

i think all the study is just supposition and not a good study at all.
to say no resistance you need ultradeep sequence, the normal resistance tests are too weak sensibility and detect mutations only when most population has the mutant, let s say more than 20%, plus to see this you need years

to me it is just a clinical report with observations with weak tests and too short time which can be considered within china but not in western countries.
guidelines for hbeag neg have the goal of hbsag seroconversion now they dont even consider a stopping for nucs
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All of this data regarding nucs btw is just a report.

We need to demand the release of drugs that work Now. That should be the focus. Enough said on Etv Tdf and interferon.

Rep9 gs9620 - immune system therapies. Detox the body. That is what we need to focus on.
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After stopping etv, I relapsed after 1yr. Now im on tdf and was told by my dr I need to be on tdf forever till hbs seroconversion (which is almost like impossible I know). So he said the other chance I can give myself is to add on peg after 1-2yrs und. But this is just a 30% chance he said.
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no it is 50% by 48weeks peg add on, 30% is the response to peinf monotherapy when started with hbvdna undetectable naturaaly and not by antivirals

your chances will depend on hbsag quant too, if hbsag is less than 1000iu/ml when you add on pegintf the hbsag clearance chances can be even higher
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