HBsAg seroclearance after nucleoside analogue therapy in patients with chronic hepatitis B: clinical outcomes and durability.
- Authors
- Kim, Gi-Ae; Lim, Young-Suk; An, Ji hyun; Lee, Danbi; Shim, Ju Hyun; Kim, Kang Mo; Lee, Han Chu; Chung, Young-Hwa; Lee, Yung Sang; Suh, Dong Jin
- Issue Date
- Aug-2014
- Publisher
- BMJ PUBLISHING GROUP
- Citation
- GUT, v.63, no.8, pp.1325 - 1332
- Indexed
- SCIE
SCOPUS
- Journal Title
- GUT
- Volume
- 63
- Number
- 8
- Start Page
- 1325
- End Page
- 1332
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/159321
- DOI
- 10.1136/gutjnl-2013-305517
- ISSN
- 0017-5749
- Abstract
- Objective Little is known about the long- Term clinical outcome and durability of HBsAg seroclearance following nucleos(t)ide analogue (NUC) therapy in patients with chronic hepatitis B (CHB). Design During a median follow-up period of 6 years (33 567 patient-years) of 5409 CHB patients who were initially treated with lamivudine or entecavir, a total of 110 achieved HBsAg seroclearance (0.33% annual seroclearance rate) and were included in this study. Results Baseline alanine aminotransferase (ALT) level >5 times of upper limit of normal was associated with higher probability of HBsAg seroclearance (HR 1.80, p<0.01), while HBeAg positivity (HR 0.46, p<0.01), high HBV DNA level (log10 IU/mL; HR 0.61, p<0.01), and cirrhosis (HR 0.48, p<0.01) were inversely associated with the probability of HBsAg seroclearance by multivariable analysis. During follow-up for 287 patient-years after HBsAg seroclearance, only two patients with baseline cirrhosis developed hepatocellular carcinoma (HCC) or died (0.7% annual risk), which was of a significantly lower rate compared with propensity score-matched patients without HBsAg seroclearance (HR 0.09, p<0.01). HBsAg reversion and/or HBV DNA reversion occurred in 18 patients, most of which were transient with extremely low serum levels of HBsAg (0.05-1.00 IU/mL) and HBV DNA (17-1818 IU/mL). None required retreatment. The cumulative probability of anti-HBs seroconversion (detection of anti-HBs) at 4 years was 67.4% by Kaplan-Meier analysis. Selection for lamivudine-resistance HBV mutants during treatment was not associated with composite reversion ( p=0.66). Conclusions HBsAg seroclearance achieved after NUC treatment was associated with favourable clinical outcomes and was durable in most cases during longterm follow-up.
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