easl2013 stopping longterm nucs in hbeag neg

[stef2011]

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. *[email protected]

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.


Assigned speakers:
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

[veteranB]

that is why I say we need researchers to come here and interact with us. There has to be a better way in treating HBV. Look how much is known.. But this is very interesting finding..

[veteranB]

They need to look at people immune system structure in those that control HBV as to why this is the case..

This is very interesting topic, that we hear about often.. But patient was on nucs, stopped them VL shot back up, then HBV cleared... But why? This happens in some and not others?