Antiviral response is not sustained after cessation of lamivudine treatment in chronic hepatitis B patients: A 10-year follow-up study

Seong Hee Kang, Keunhee Kang, Jong Eun Yeon, Young-Sun Lee, Tae Suk Kim, Yang Jae Yoo, Sang Jun Suh, Eileen L. Yoon, Young Kul Jung, Ji Hoon Kim, Yeon Seok Seo, Hyung Joon Yim, Kwan Soo Byun

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Although the ideal end point for antiviral treatment in patients with chronic hepatitis B (CHB) is loss of HBsAg, the typical clinical end points are HBeAg seroconversion in HBeAg-positive patients and long-term DNA suppression in HBeAg-negative patients. We evaluated the long-term antiviral response after cessation of lamivudine treatment in CHB patients. A total of 157 patients who had discontinued lamivudine between 1997 and 2014 were enrolled (97 HBeAg-positive and 60 HBeAg-negative CHB patients). The long-term durability of the antiviral response (viralogical relapse; HBV DNA ≥104 copies/ml) and the clinical course of these patients were analyzed retrospectively. In HBeAg-positive patients, the mean follow-up period after discontinuation was 72.3 months. The cumulative probabilities of virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 10.3%, 40.2%, 55.6%, 62.8%, 65.9%, 67.0%, and 67.0%, respectively. In HBeAg-negative patients, the cumulative probabilities of a virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 25.0%, 35.0%, 41.7%, 43.3%, 43.3%, 46.7%, and 48.3%, respectively. Younger age (HR 1.732, 95%CI: 1.058–2.835, P = 0.02) was predictive of non-virological relapse in HBeAg-positive patients. And achievement of undetectable HBV DNA level within 3 months of treatment discontinuation was associated with decreased rate of virological relapse (HR 0.159, 95%CI: 0.069–0.367 P < 0.01) in HBeAg-negative patients. Despite meeting the requirements for treatment discontinuation, approximately half of the CHB patients treated with lamivudine relapsed. Thus, the antiviral response is not reliably sustained after lamivudine treatment cessation. J. Med. Virol. 89:849–856, 2017.

Original languageEnglish
Pages (from-to)849-856
Number of pages8
JournalJournal of Medical Virology
Volume89
Issue number5
DOIs
Publication statusPublished - 2017 May 1

Fingerprint

Withholding Treatment
Lamivudine
antineoplaston A10
Chronic Hepatitis B
Antiviral Agents
Hepatitis B e Antigens
Recurrence
DNA
Hepatitis B Surface Antigens
Therapeutics

Keywords

  • antiviral therapy
  • chronic hepatitis B
  • discontinuation
  • durability

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

Cite this

Antiviral response is not sustained after cessation of lamivudine treatment in chronic hepatitis B patients : A 10-year follow-up study. / Kang, Seong Hee; Kang, Keunhee; Yeon, Jong Eun; Lee, Young-Sun; Kim, Tae Suk; Yoo, Yang Jae; Suh, Sang Jun; Yoon, Eileen L.; Jung, Young Kul; Kim, Ji Hoon; Seo, Yeon Seok; Yim, Hyung Joon; Byun, Kwan Soo.

In: Journal of Medical Virology, Vol. 89, No. 5, 01.05.2017, p. 849-856.

Research output: Contribution to journalArticle

@article{753dda96737d4aada5fc7fc52916bc53,
title = "Antiviral response is not sustained after cessation of lamivudine treatment in chronic hepatitis B patients: A 10-year follow-up study",
abstract = "Although the ideal end point for antiviral treatment in patients with chronic hepatitis B (CHB) is loss of HBsAg, the typical clinical end points are HBeAg seroconversion in HBeAg-positive patients and long-term DNA suppression in HBeAg-negative patients. We evaluated the long-term antiviral response after cessation of lamivudine treatment in CHB patients. A total of 157 patients who had discontinued lamivudine between 1997 and 2014 were enrolled (97 HBeAg-positive and 60 HBeAg-negative CHB patients). The long-term durability of the antiviral response (viralogical relapse; HBV DNA ≥104 copies/ml) and the clinical course of these patients were analyzed retrospectively. In HBeAg-positive patients, the mean follow-up period after discontinuation was 72.3 months. The cumulative probabilities of virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 10.3{\%}, 40.2{\%}, 55.6{\%}, 62.8{\%}, 65.9{\%}, 67.0{\%}, and 67.0{\%}, respectively. In HBeAg-negative patients, the cumulative probabilities of a virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 25.0{\%}, 35.0{\%}, 41.7{\%}, 43.3{\%}, 43.3{\%}, 46.7{\%}, and 48.3{\%}, respectively. Younger age (HR 1.732, 95{\%}CI: 1.058–2.835, P = 0.02) was predictive of non-virological relapse in HBeAg-positive patients. And achievement of undetectable HBV DNA level within 3 months of treatment discontinuation was associated with decreased rate of virological relapse (HR 0.159, 95{\%}CI: 0.069–0.367 P < 0.01) in HBeAg-negative patients. Despite meeting the requirements for treatment discontinuation, approximately half of the CHB patients treated with lamivudine relapsed. Thus, the antiviral response is not reliably sustained after lamivudine treatment cessation. J. Med. Virol. 89:849–856, 2017.",
keywords = "antiviral therapy, chronic hepatitis B, discontinuation, durability",
author = "Kang, {Seong Hee} and Keunhee Kang and Yeon, {Jong Eun} and Young-Sun Lee and Kim, {Tae Suk} and Yoo, {Yang Jae} and Suh, {Sang Jun} and Yoon, {Eileen L.} and Jung, {Young Kul} and Kim, {Ji Hoon} and Seo, {Yeon Seok} and Yim, {Hyung Joon} and Byun, {Kwan Soo}",
year = "2017",
month = "5",
day = "1",
doi = "10.1002/jmv.24715",
language = "English",
volume = "89",
pages = "849--856",
journal = "Journal of Medical Virology",
issn = "0146-6615",
publisher = "Wiley-Liss Inc.",
number = "5",

}

TY - JOUR

T1 - Antiviral response is not sustained after cessation of lamivudine treatment in chronic hepatitis B patients

T2 - A 10-year follow-up study

AU - Kang, Seong Hee

AU - Kang, Keunhee

AU - Yeon, Jong Eun

AU - Lee, Young-Sun

AU - Kim, Tae Suk

AU - Yoo, Yang Jae

AU - Suh, Sang Jun

AU - Yoon, Eileen L.

AU - Jung, Young Kul

AU - Kim, Ji Hoon

AU - Seo, Yeon Seok

AU - Yim, Hyung Joon

AU - Byun, Kwan Soo

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Although the ideal end point for antiviral treatment in patients with chronic hepatitis B (CHB) is loss of HBsAg, the typical clinical end points are HBeAg seroconversion in HBeAg-positive patients and long-term DNA suppression in HBeAg-negative patients. We evaluated the long-term antiviral response after cessation of lamivudine treatment in CHB patients. A total of 157 patients who had discontinued lamivudine between 1997 and 2014 were enrolled (97 HBeAg-positive and 60 HBeAg-negative CHB patients). The long-term durability of the antiviral response (viralogical relapse; HBV DNA ≥104 copies/ml) and the clinical course of these patients were analyzed retrospectively. In HBeAg-positive patients, the mean follow-up period after discontinuation was 72.3 months. The cumulative probabilities of virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 10.3%, 40.2%, 55.6%, 62.8%, 65.9%, 67.0%, and 67.0%, respectively. In HBeAg-negative patients, the cumulative probabilities of a virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 25.0%, 35.0%, 41.7%, 43.3%, 43.3%, 46.7%, and 48.3%, respectively. Younger age (HR 1.732, 95%CI: 1.058–2.835, P = 0.02) was predictive of non-virological relapse in HBeAg-positive patients. And achievement of undetectable HBV DNA level within 3 months of treatment discontinuation was associated with decreased rate of virological relapse (HR 0.159, 95%CI: 0.069–0.367 P < 0.01) in HBeAg-negative patients. Despite meeting the requirements for treatment discontinuation, approximately half of the CHB patients treated with lamivudine relapsed. Thus, the antiviral response is not reliably sustained after lamivudine treatment cessation. J. Med. Virol. 89:849–856, 2017.

AB - Although the ideal end point for antiviral treatment in patients with chronic hepatitis B (CHB) is loss of HBsAg, the typical clinical end points are HBeAg seroconversion in HBeAg-positive patients and long-term DNA suppression in HBeAg-negative patients. We evaluated the long-term antiviral response after cessation of lamivudine treatment in CHB patients. A total of 157 patients who had discontinued lamivudine between 1997 and 2014 were enrolled (97 HBeAg-positive and 60 HBeAg-negative CHB patients). The long-term durability of the antiviral response (viralogical relapse; HBV DNA ≥104 copies/ml) and the clinical course of these patients were analyzed retrospectively. In HBeAg-positive patients, the mean follow-up period after discontinuation was 72.3 months. The cumulative probabilities of virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 10.3%, 40.2%, 55.6%, 62.8%, 65.9%, 67.0%, and 67.0%, respectively. In HBeAg-negative patients, the cumulative probabilities of a virological relapse at 1, 12, 24, 48, 60, 96, and 120 months were 25.0%, 35.0%, 41.7%, 43.3%, 43.3%, 46.7%, and 48.3%, respectively. Younger age (HR 1.732, 95%CI: 1.058–2.835, P = 0.02) was predictive of non-virological relapse in HBeAg-positive patients. And achievement of undetectable HBV DNA level within 3 months of treatment discontinuation was associated with decreased rate of virological relapse (HR 0.159, 95%CI: 0.069–0.367 P < 0.01) in HBeAg-negative patients. Despite meeting the requirements for treatment discontinuation, approximately half of the CHB patients treated with lamivudine relapsed. Thus, the antiviral response is not reliably sustained after lamivudine treatment cessation. J. Med. Virol. 89:849–856, 2017.

KW - antiviral therapy

KW - chronic hepatitis B

KW - discontinuation

KW - durability

UR - http://www.scopus.com/inward/record.url?scp=85007487800&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007487800&partnerID=8YFLogxK

U2 - 10.1002/jmv.24715

DO - 10.1002/jmv.24715

M3 - Article

C2 - 27769101

AN - SCOPUS:85007487800

VL - 89

SP - 849

EP - 856

JO - Journal of Medical Virology

JF - Journal of Medical Virology

SN - 0146-6615

IS - 5

ER -