Akihiro Matsumoto1, Eiji Tanaka, Yoshiyuki Suzuki, Mariko Kobayashi, Yasuhito Tanaka, Noboru Shinkai, Shuhei Hige, Hiroshi Yatsuhashi, Shinya Nagaoka, Kazuaki Chayama, Masataka Tsuge, Osamu Yokosuka, Fumio Imazeki, Shuhei Nishiguchi, Masaki Saito, Kei Fujiwara, Nobuyuki Torii, Naoki Hiramatsu, Yoshiyasu Karino, Hiromitsu Kumada. 1. Department of Medicine, Shinshu University School of Medicine, Matsumoto Department of Hepatology, Toranomon Hospital Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences Gastroenterology Section, Nagoya Daini Red Cross Hospital, Nagoya Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo The Clinical Research Center, NHO Nagasaki Medical Center, Omura Program for Biomedical Research, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba Division of Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo College of Medicine, Hyogo Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Abstract
AIM: The factors associated with hepatitis recurrence after discontinuation of nucleos(t)ide analogs (NAs) in patients with chronic hepatitis B were analyzed to predict the risk of relapse more accurately. METHODS: A total of 126 patients who discontinued NA therapy were recruited retrospectively. The clinical conditions of a successful discontinuation were set as alanine aminotransferase (ALT) below 30 IU/L and serum hepatitis B virus (HBV) DNA below 4.0 log copies/mL. RESULTS: Relapse of hepatitis B were judged to occur when maximal serum ALT became higher than 79 IU/L or when maximal serum HBV DNA surpassed 5.7 log copies/mL following NA discontinuation since these values corresponded with mean values of ALT (30 IU/L) and HBV DNA (4.0 log copies/mL), respectively. At least 90% of patients with either detectable hepatitis B e antigen or serum HBV DNA higher than 3.0 log copies/mL at the time of NA discontinuation relapsed within one year. In the remaining patients, higher levels of both hepatitis B surface and core-related antigens at the time of discontinuation, as well as a shorter course of NA treatment, were significantly associated with relapse by multivariate analysis. CONCLUSIONS: It appears that negative results for hepatitis B e antigen and serum HBV DNA lower than 3.0 log copies/mL are essential for successful NA discontinuation, which may be attained by a longer treatment period. Levels of hepatitis B surface and core-related antigens are also significant factors independently associated with relapse of hepatitis.
AIM: The factors associated with hepatitis recurrence after discontinuation of nucleos(t)ide analogs (NAs) in patients with chronic hepatitis B were analyzed to predict the risk of relapse more accurately. METHODS: A total of 126 patients who discontinued NA therapy were recruited retrospectively. The clinical conditions of a successful discontinuation were set as alanine aminotransferase (ALT) below 30 IU/L and serum hepatitis B virus (HBV) DNA below 4.0 log copies/mL. RESULTS: Relapse of hepatitis B were judged to occur when maximal serum ALT became higher than 79 IU/L or when maximal serum HBV DNA surpassed 5.7 log copies/mL following NA discontinuation since these values corresponded with mean values of ALT (30 IU/L) and HBV DNA (4.0 log copies/mL), respectively. At least 90% of patients with either detectable hepatitis B e antigen or serum HBV DNA higher than 3.0 log copies/mL at the time of NA discontinuation relapsed within one year. In the remaining patients, higher levels of both hepatitis B surface and core-related antigens at the time of discontinuation, as well as a shorter course of NA treatment, were significantly associated with relapse by multivariate analysis. CONCLUSIONS: It appears that negative results for hepatitis B e antigen and serum HBV DNA lower than 3.0 log copies/mL are essential for successful NA discontinuation, which may be attained by a longer treatment period. Levels of hepatitis B surface and core-related antigens are also significant factors independently associated with relapse of hepatitis.