For HBeAg-positive patients with chronic hepatitis B, how long is the best consolidation treatment time?

Introduction Hepatitis B virus (HBV) infection is still a worldwide health problem.

Since the application of nucleoside (acid) analogs (NAs), the clinical outcomes of patients with chronic hepatitis B (CHB) have been greatly improved.

However, eradication of the virus is still difficult, and the end point of NAs treatment is still controversial.

Hepatitis B e antigen (HBeAg)-positive CHB patients seem to have better outcomes after stopping treatment than HBeAg-negative CHB patients, and longer consolidation therapy may improve the outcome after NAs discontinuation.

The American Society for the Study of Liver Diseases (AASLD) guidelines recommend that patients with HBeAg-positive CHB who have undergone HBeAg seroconversion can stop NAs after a period of consolidation therapy, but only recommend consolidation therapy for at least 12 months.
Is the consolidation therapy for longer periods of time recommended? Will further reduce virological recurrence is still uncertain.

Scholars from Qilu Medical College of Shandong University and other places conducted a retrospective analysis of a prospective and observational cohort study 20 years ago, aiming to evaluate the long-term prognosis of HBeAg-positive CHB patients after NAs discontinuation and NAs consolidation treatment for patients The impact of the outcome, and determine the best time for consolidation therapy.

Study Introduction This study included HBeAg-positive CHB patients who were treated at the Second Hospital of Qilu Medical College of Shandong University and stopped NAs from December 2001 to January 2020.

When the following conditions occur, patients should stop NAs: 1.
NAs treatment should continue for at least 12 months; 2.
HBeAg seroconversion occurs, HBV DNA is undetectable, and alanine aminotransferase (ALT) levels are normal; 3.
Additional at least 6 months of consolidation treatment time.

This study retrospectively collected the baseline characteristics of selected patients at the beginning of NAs treatment.

Patients were followed up every month for the first 4 months after NAs was stopped, and then every quarter until the 12th month, and every 6 months thereafter.

Virological recurrence is the primary endpoint of the study, which is defined as serum HBV DNA>104 copies/ml (at least two weeks later, another test will be performed for confirmation).

Propensity score matching analysis (PSM) was used to balance the baseline characteristics of HBeAg-positive CHB patients under different consolidation treatment time.

The results of the study included a total of 190 HBeAg-positive CHB patients, and all patients have reached HBeAg seroconversion.

1.
The long-term prognosis of patients after NAs was discontinued.
Among them, 54 patients had virological recurrence during the follow-up period.
The cumulative recurrence rates for the first 1, 3, 5 and 10 years were 19.
5%, 24.
1%, 27.
2% and 32.
1%, respectively.

Most patients (61.
1%) relapsed within the first 6 months.

2.
The effect of NAs consolidation therapy on patient outcomes.
After PSM, the cumulative recurrence rate of patients with consolidation therapy ≥36 months was significantly lower than that of patients with consolidation therapy <36 months (the cumulative recurrence rate at the 10th year was 29.
3% vs.
52.
8%, p=0.
012).

Conclusion For HBeAg-positive CHB patients, long-term consolidation therapy after HBeAg seroconversion is safe and feasible.

Consolidation treatment for at least 3 years should be considered in clinical practice.

Literature index: Li T, Liang Y, Zhang M, et al.
Nucleos(t)ide analogues consolidation therapy in HBeAg-positive chronic hepatitis B patients: three years should be preferred[J].
Hepatol Res.
2021 Mar 27.
Contribution email : Tougao@medlive.
cn