Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV
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HEPATITIS B (J LIM, SECTION EDITOR)
Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV Maximilian Wübbolding 1 & Markus Cornberg 1,2,3,4,5 & Christoph Höner zu Siederdissen 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of Review To review the evidence for stopping antiviral therapy with nucleos(t)ide analogues (NA) in patients with chronic hepatitis B. Recent Findings HBsAg loss is usually stable even without anti-HBs seroconversion after stopping NA therapy. About 50% of HBeAg-positive patients who have achieved anti-HBe seroconversion and have stopped NA therapy remain in virological remission. Consolidation therapy increases the response rate. In HBeAg-negative hepatitis, stable virological remission is documented in 30% after NA discontinuation. Interestingly, some studies document unexpectedly high long-term HBsAg loss rates after stopping therapy. Summary Evidence supports NA discontinuation, especially after HBsAg seroclearance. In HBeAg-positive patients, NA can be stopped 12 months after anti-HBe seroconversion but severe flares have to be considered. NA discontinuation is also possible in selected HBeAg-negative patients if close monitoring can be guaranteed. The high rate of HBsAg loss needs further evaluation. Keywords Treatment discontinuation . Nucleos(t)ide analogues . HBeAg seroconversion . HBeAg negative . HBsAg loss
Introduction The major international guidelines from AASLD, APASL, and EASL give similar recommendations for starting antiviral therapy with nucleos(t)ide analogues (NA) in chronic hepatitis B virus (HBV) infection [1–3] This article is part of the Topical Collection on Hepatitis B * Markus Cornberg [email protected] 1
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany
2
German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Carl-Neuberg Strasse 1, Hannover, Germany
3
Centre for Individualised Infection Medicine (CIIM), Feodor-Lynen-Straße 15, Hannover, Germany
4
Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
5
Cluster of Excellence Resolving Infection Susceptibility (RESIST; EXC), Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany
(Table 1). These recommendations, as well as the benefits of antiviral therapy, are backed up by an increasing amount of evidence. Antiviral therapy with NA reduces the incidence of hepatocellular carcinoma (HCC) and progression of liver cirrhosis and improves survival [1–3]. On the contrary, research focusing on stopping NA therapy is limited. Based on the available data, three possible time points have been suggested to stop antiviral therapy: (a) after HBsAg loss, (b) after anti-HBe seroconversion, and (c) in HBeAg-negative patients after a varying duration of consolidation therapy. While guidelines are in accordance on stopping antiviral therapy in patients after HBsAg loss, increasing differences exist for HBsAgpositive pat
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