Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: A nationwide multicentre study

Minseok Albert Kim, Seung Up Kim, Dong Hyun Sinn, Jeong Won Jang, Young Suk Lim, Sang Hoon Ahn, Jae Jun Shim, Yeon Seok Seo, Yang Hyun Baek, Sang Gyune Kim, Young Seok Kim, Ji Hoon Kim, Won Hyeok Choe, Hyung Joon Yim, Hyun Woong Lee, Jung Hyun Kwon, Sung Won Lee, Jae Young Jang, Hwi Young Kim, Yewan ParkGi Ae Kim, Hyun Yang, Han Ah Lee, Myeongseok Koh, Young Sun Lee, Minkoo Kim, Young Chang, Yoon Jun Kim, Jung Hwan Yoon, Fabien Zoulim, Jeong Hoon Lee

Research output: Contribution to journalArticle

Abstract

Objective: Direct comparison of the clinical outcomes between nucleos(t)ide analogue (NA) discontinuation versus NA continuation has not been performed in patients with chronic hepatitis B who achieved HBsAg-seroclearance. Whether NA discontinuation was as safe as NA continuation after NA-induced surface antigen of HBV (HBsAg) seroclearance was investigated in the present study. Designs: This multicentre study included 276 patients from 16 hospitals in Korea who achieved NA-induced HBsAg seroclearance: 131 (47.5%) discontinued NA treatment within 6 months after HBsAg seroclearance (NA discontinuation group) and 145 (52.5%) continued NA treatment (NA continuation group). Primary endpoint was HBsAg reversion and secondary endpoints included serum HBV DNA redetection and development of hepatocellular carcinoma (HCC). Results: During follow-up (median=26.9 months, IQR=12.2-49.2 months), 10 patients (3.6%) experienced HBsAg reversion, 6 (2.2%) showed HBV DNA redetection and 8 (2.9%) developed HCC. Compared with NA continuation, NA discontinuation was not associated with HBsAg reversion in both univariable (HR=0.45, 95% CI=0.12 to 1.76, log-rank p=0.24) and multivariable analyses (adjusted HR=0.65, 95% CI=0.16 to 2.59, p=0.54). The cumulative probabilities of HBsAg reversion at 1, 3 and 5 years were 0.8%, 2.3% and 5.0% in the NA discontinuation group, and 1.5%, 6.3% and 8.4% in the NA continuation group, respectively. NA discontinuation was not associated with higher risk of either HBV redetection (HR=0.83, 95% CI=0.16 to 4.16, log-rank p=0.82) or HCC development (HR=0.53, 95% CI=0.12 to 2.23, log-rank p=0.38). Conclusion: The discontinuation of NA was not associated with a higher risk of either HBsAg reversion, serum HBV DNA redetection or HCC development compared with NA continuation among patients who achieved HBsAg seroclearance with NA.

Original languageEnglish
Article number32209606
JournalGut
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • HBV DNA redetection
  • HBsAg
  • antivirals
  • hepatocellular carcinoma

ASJC Scopus subject areas

  • Gastroenterology

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    Kim, M. A., Kim, S. U., Sinn, D. H., Jang, J. W., Lim, Y. S., Ahn, S. H., Shim, J. J., Seo, Y. S., Baek, Y. H., Kim, S. G., Kim, Y. S., Kim, J. H., Choe, W. H., Yim, H. J., Lee, H. W., Kwon, J. H., Lee, S. W., Jang, J. Y., Kim, H. Y., ... Lee, J. H. (Accepted/In press). Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: A nationwide multicentre study. Gut, [32209606]. https://doi.org/10.1136/gutjnl-2019-320015