Tse-Ling Fong1,2, Andy Tien3, Kahee J Jo4, Danny Chu5, Eddie Cheung6,7, Edward A Mena8, Quang-Quoc Phan9, Andy S Yu10, Wafa Mohammed3, Andrew Velasco3, Vinh-Huy LeDuc3, Nickolas Nguyen3, Steven-Bui Han11, Mimi Chang3, Ho S Bae3, Yong-Won Cho3, Myron J Tong8, Stewart L Cooper4. 1. Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA. tselingf@usc.edu. 2. Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2/F, Los Angeles, CA, 90033, USA. tselingf@usc.edu. 3. Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA. 4. Liver Disease and Transplant Program, California Pacific Medical Center, San Francisco, CA, USA. 5. Private Practice, New York, NY, USA. 6. Division of Gastroenterology, University of California Davis, Davis, CA, USA. 7. Private Practice, Oakland, CA, USA. 8. Liver Center, Huntington Research Institute, Pasadena, CA, USA. 9. Private Practice, Fountain Valley, CA, USA. 10. Private Practice, San Jose, CA, USA. 11. Division of Gastroenterology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Abstract
INTRODUCTION: Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied. METHODS: We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment. RESULTS: Only 4 (7%) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24%) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69%) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62%) remained HBeAg negative/anti-HBe positive, 12 (32%) became HBeAg positive, and 2 (5%) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse. CONCLUSIONS: Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.
INTRODUCTION: Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied. METHODS: We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment. RESULTS: Only 4 (7%) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24%) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69%) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62%) remained HBeAg negative/anti-HBe positive, 12 (32%) became HBeAg positive, and 2 (5%) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse. CONCLUSIONS: Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.
Authors: Patrick Marcellin; Edward Gane; Maria Buti; Nezam Afdhal; William Sievert; Ira M Jacobson; Mary Kay Washington; George Germanidis; John F Flaherty; Raul Aguilar Schall; Jeffrey D Bornstein; Kathryn M Kitrinos; G Mani Subramanian; John G McHutchison; E Jenny Heathcote Journal: Lancet Date: 2012-12-10 Impact factor: 79.321
Authors: Kwan Soo Byun; Oh Sang Kwon; Ju Hyun Kim; Hyung Joon Yim; Yun Jung Chang; Jin Yong Kim; Jong Eun Yeon; Jong Jae Park; Jae Seon Kim; Young Tae Bak; Chang Hong Lee Journal: J Gastroenterol Hepatol Date: 2005-12 Impact factor: 4.029
Authors: Jules L Dienstag; Janusz Cianciara; Selim Karayalcin; Kris V Kowdley; Bernard Willems; Stanilav Plisek; Mary Woessner; Stephen Gardner; Eugene Schiff Journal: Hepatology Date: 2003-04 Impact factor: 17.425
Authors: Hyun Woong Lee; Heon Ju Lee; Jae Seok Hwang; Joo Hyun Sohn; Jae Young Jang; Ki Jun Han; Jun Yong Park; Do Young Kim; Sang Hoon Ahn; Yong Han Paik; Chun Kyon Lee; Kwan Sik Lee; Chae Yoon Chon; Kwang-Hyub Han Journal: Hepatology Date: 2010-02 Impact factor: 17.425
Authors: G Fattovich; M Rugge; L Brollo; P Pontisso; F Noventa; M Guido; A Alberti; G Realdi Journal: Hepatology Date: 1986 Mar-Apr Impact factor: 17.425
Authors: Carla S Coffin; Scott K Fung; Fernando Alvarez; Curtis L Cooper; Karen E Doucette; Claire Fournier; Erin Kelly; Hin Hin Ko; Mang M Ma; Steven R Martin; Carla Osiowy; Alnoor Ramji; Edward Tam; Jean Pierre Villeneuve Journal: Can Liver J Date: 2018-12-25
Authors: Rui Guo; Yi Tian; Xueyuan Jin; Haiyan Chen; Guihu Wang; Xiaozhong Huang; Burong Li; Zongfang Li; Jun Yang Journal: Nan Fang Yi Ke Da Xue Xue Bao Date: 2019-09-30