Clinical Relapse After Cessation of Tenofovir Therapy in Hepatitis B e Antigen-Negative Patients

被引：75

作者：

Jeng, Wen-Juei ^{[1
,2
,6
]}

Chen, Yi-Cheng ^{[1
,2
,6
]}

Sheen, I-Shyan ^{[1
,2
,6
]}

Lin, Chih-Lang ^{[3
,6
]}

Hu, Tsung-Hui ^{[4
,5
,6
]}

Chien, Rong-Nan ^{[3
,6
]}

Liaw, Yun-Fan ^{[1
,6
]}

机构：

[1] Chang Gung Mem Hosp, Liver Res Unit, Linkou, Taiwan

[2] Chang Gung Mem Hosp, Dept Gastroenterol & Hepatol, Div Hepatol, Linkou, Taiwan

[3] Chang Gung Mem Hosp, Liver Res Unit, Keelung, Taiwan

[4] Chang Gung Mem Hosp, Liver Res Unit, Kaohsiung, Taiwan

[5] Chang Gung Mem Hosp, Dept Internal Med, Div Hepatogastroenterol, Kaohsiung, Taiwan

[6] Chang Gung Univ, Coll Med, Taoyuan, Taiwan

来源：

Clinical Gastroenterology and Hepatology | 2016年 / 14卷 / 12期

关键词：

Chronic Hepatitis B; Consolidation Therapy; Hepatic Decompensation; Hepatitis B Surface Antigen; Cirrhosis; ENTECAVIR THERAPY; NUCLEOS(T)IDE ANALOGS; SURFACE-ANTIGEN; DISCONTINUATION; DECOMPENSATION; SUPPRESSION; DURABILITY; OUTCOMES;

D O I：

10.1016/j.cgh.2016.07.002

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Of the hepatitis B e antigen-negative chronic hepatitis B patients with more than 1 year of sustained hepatitis B virus (HBV) suppression during therapy, the 1-year clinical relapse rate after cessation of entecavir therapy was 45%, of which 25.6% occurred within 6 months. The events after cessation of another preferred drug tenofovir were investigated. METHODS: A retrospective-prospective study was conducted in 85 hepatitis B e antigen-negative chronic hepatitis B patients with sustained HBV suppression who had stopped tenofovir therapy and were monitored every 1 to 3 months for a median duration of 39 weeks (range, 4-133 wk). RESULTS: Clinical relapse occurred in 38 patients, 57.9% and 86.8% within 3 and 6 months, respectively, with an estimated 1-year cumulative incidence of 52%. The optimal duration of therapy and consolidation therapy were calculated to be 3 and 2 years, respectively. Of the relapsers, 81.6% and 57.9% showed an alanine aminotransferase level greater than 5 and 10 times the upper limit of normal, respectively, 23.7% showed a bilirubin level of 2 mg/dL or greater, and 2 developed hepatic decompensation. Relapsers had significantly higher pretherapy baseline hepatitis B surface antigen level, more prior anti-HBV therapy experience, later alanine aminotransferase level normalization, and a shorter duration of treatment and consolidation therapy. Cox regression analyses showed that treatment for more than 3 years combined with consolidation therapy for more than 2 years was an independent significant manageable factor of clinical relapse (adjusted hazard ratio, 0.387; P = .008). With this combination, the clinical relapse rate was reduced to 30%. CONCLUSIONS: Clinical relapses occurred mostly within 6 months, with high alanine aminotransferase and serum bilirubin levels. Closer monitoring, monthly in the first 3 to 6 months, with timely re-treatment is mandatory for a safe cessation of tenofovir therapy.

引用

页码：1813 / 1820

页数：8

共 21 条

[1] Entecavir safety and effectiveness in a national cohort of treatment-naive chronic hepatitis B patients in the US - the ENUMERATE study [J].