STOPPING LONG-TERM NUCLEOS(T)IDE ANALOGUE THERAPY BEFORE HBSAG LOSS IN HBEAG NEGATIVE CHB PATIENTS: FOLLOW-UP OF LONG TERM RESPONDERS
J. Petersen1*, P. Buggisch1, H. Hinrichsen2, T. Berg3, H. Wedemeyer4, M. Cornberg4, A. Stoehr1
1Liver Unit, IFI Institute for Interdisciplinary Medicine, Asklepios Clinics St. Georg Hamburg, Hamburg+, 2Gastroenterology, Gastroenterologische Schwerpunkt Praxis, Kiel, 3Gastroenterology and Hepatology, University of Leipzig, Leipzig, 4Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany. *firstname.lastname@example.org
Background and aim: Long-term treatment with nucleos(t)ide analogues (NUC) is highly effective but HBsAg loss is a rare event in HBeAg-negative patients. Small pilot trials have challenged the question of sustained remission after discontinuation of long-term NUC-therapy in some patients. We recently reported on high relapse rates (72%) after treatment discontinuation in 32 HBeAg-negative patients (AASLD 2011). Here we report on the long-term outcome of patients without HBV relapse after stopping antiviral treatment after 37-80 months.
Methods: 9/32 patients without relapse were identified by retrospective data base search. These patients were prospectively followed (median 24 months).
Results: All patients were HBeAg-negative, 7/9 male, median age 43 years, genotype A or D. Three patients had received lamivudine, two adefovir, one telbivudine, and three entecavir. At stopping treatment all responder patients showed qHBsAg levels of < 1000IU/ml, six lost HBsAg off therapy (at months 6, 9, 12, 14, 20, 28) and three of these developed anti-HBs (16, 18, 26 months after treatment termination). All nine patients showed an ongoing reduction of qHBsAg levels, demonstrated long-term normal or close to normal ALT-levels, with HBV-DNA ranging from undetectable levels to 6.9x103 log IU/ml. No patient displayed apparent liver disease progression by regular fibroscans, whereas a trend towards improvement (albeit not significant) could be detected.
Conclusion: Stopping long-term NUC therapy in HBeAg-negative CHB patients with non-advanced liver disease might be an option for patients with HBsAg titers < 1000IU/ml. These patients develop a high rate of HBsAg loss off-therapy and suggest that these patients may have developed some degree of immunological control of HBV during and off-treatment. Better immunological characterization of CHB patients with an indication for antiviral treatment is urgently needed to identify predictive markers to stop long-term NUC-therapy in some patients.
Prof. Jorg Petersen, IFI Institute at the, Asklepios Klinik St Georg Hamburg , Hamburg , Germany
Assigned in sessions:
26.04.2013, 09:00-18:00, Poster Session, P02-07c, Category 07c: Viral Hepatitis B & D: Clinical (therapy, new compounds, resistance), Poster Area
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