Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation

Chronic hepatitis B (CHB) with severe acute exacerbation (SAE) is an urgent problem requiring nucleos(t)ide analogue (NA) therapy. We aim to evaluate the clinical relapse (CR) risk after discontinuing NA in patients with prior SAE. Methods: In this retrospective cohort study, CHB patients who discon...

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Autores principales:	Chia-Yeh Lai, Sheng-Shun Yang, Shou-Wu Lee, Hsin-Ju Tsai, Teng-Yu Lee
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	hepatitis flare liver failure hepatitis B virus antivirals discontinuation Medicine R
Acceso en línea:	https://doaj.org/article/6eda9f4774af474585feb9d310c061d1
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spelling	oai:doaj.org-article:6eda9f4774af474585feb9d310c061d12021-11-11T17:32:23ZCessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation10.3390/jcm102148832077-0383https://doaj.org/article/6eda9f4774af474585feb9d310c061d12021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4883https://doaj.org/toc/2077-0383Chronic hepatitis B (CHB) with severe acute exacerbation (SAE) is an urgent problem requiring nucleos(t)ide analogue (NA) therapy. We aim to evaluate the clinical relapse (CR) risk after discontinuing NA in patients with prior SAE. Methods: In this retrospective cohort study, CHB patients who discontinued NA therapy were screened between October, 2003 and January, 2019. A total of 78 non-cirrhotic patients who had received NA therapy for CHB with SAE, i.e., bilirubin ≥ 2 mg/dL and/or prothrombin time prolongation ≥3 s, (SAE group) were matched 1:2 with 156 controls without SAE (non-SAE group) by means of propensity scores (age, gender, NA categories, NA therapy duration, and HBeAg status). Results: The 5-year cumulative incidences of severe CR, i.e., ALT > 10X ULN, (42.78%, 95% CI: 27.84–57.73% vs. 25.42%, 95% CI: 16.26–34.58%; <i>p</i> = 0.045) and SAE recurrence (25.91%, 95% CI: 10.91–40.91% vs. 1.04%, 95% CI: 0–3.07%; <i>p</i> < 0.001) were significantly higher in the SAE group. Prior SAE history (HR 1.79, 95% CI: 1.04–3.06) was an independent factor for severe CR. The 5-year cumulative incidence of HBsAg seroclearance was significantly higher in the SAE group than that in the non-SAE group (16.82%, 95% CI: 2.34–31.30% vs. 6.02%, 95% CI: 0–13.23%; <i>p</i> = 0.049). Conclusions: Even though it creates a greater chance of HBsAg seroclearance, NA therapy cessation may result in a high risk of severe CR in non-cirrhotic CHB patients with prior SAE.Chia-Yeh LaiSheng-Shun YangShou-Wu LeeHsin-Ju TsaiTeng-Yu LeeMDPI AGarticlehepatitis flareliver failurehepatitis B virusantiviralsdiscontinuationMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4883, p 4883 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hepatitis flare liver failure hepatitis B virus antivirals discontinuation Medicine R
spellingShingle	hepatitis flare liver failure hepatitis B virus antivirals discontinuation Medicine R Chia-Yeh Lai Sheng-Shun Yang Shou-Wu Lee Hsin-Ju Tsai Teng-Yu Lee Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
description	Chronic hepatitis B (CHB) with severe acute exacerbation (SAE) is an urgent problem requiring nucleos(t)ide analogue (NA) therapy. We aim to evaluate the clinical relapse (CR) risk after discontinuing NA in patients with prior SAE. Methods: In this retrospective cohort study, CHB patients who discontinued NA therapy were screened between October, 2003 and January, 2019. A total of 78 non-cirrhotic patients who had received NA therapy for CHB with SAE, i.e., bilirubin ≥ 2 mg/dL and/or prothrombin time prolongation ≥3 s, (SAE group) were matched 1:2 with 156 controls without SAE (non-SAE group) by means of propensity scores (age, gender, NA categories, NA therapy duration, and HBeAg status). Results: The 5-year cumulative incidences of severe CR, i.e., ALT > 10X ULN, (42.78%, 95% CI: 27.84–57.73% vs. 25.42%, 95% CI: 16.26–34.58%; <i>p</i> = 0.045) and SAE recurrence (25.91%, 95% CI: 10.91–40.91% vs. 1.04%, 95% CI: 0–3.07%; <i>p</i> < 0.001) were significantly higher in the SAE group. Prior SAE history (HR 1.79, 95% CI: 1.04–3.06) was an independent factor for severe CR. The 5-year cumulative incidence of HBsAg seroclearance was significantly higher in the SAE group than that in the non-SAE group (16.82%, 95% CI: 2.34–31.30% vs. 6.02%, 95% CI: 0–13.23%; <i>p</i> = 0.049). Conclusions: Even though it creates a greater chance of HBsAg seroclearance, NA therapy cessation may result in a high risk of severe CR in non-cirrhotic CHB patients with prior SAE.
format	article
author	Chia-Yeh Lai Sheng-Shun Yang Shou-Wu Lee Hsin-Ju Tsai Teng-Yu Lee
author_facet	Chia-Yeh Lai Sheng-Shun Yang Shou-Wu Lee Hsin-Ju Tsai Teng-Yu Lee
author_sort	Chia-Yeh Lai
title	Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
title_short	Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
title_full	Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
title_fullStr	Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
title_full_unstemmed	Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
title_sort	cessation of nucleos(t)ide analogue therapy in non-cirrhotic hepatitis b patients with prior severe acute exacerbation
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6eda9f4774af474585feb9d310c061d1
work_keys_str_mv	AT chiayehlai cessationofnucleostideanaloguetherapyinnoncirrhotichepatitisbpatientswithpriorsevereacuteexacerbation AT shengshunyang cessationofnucleostideanaloguetherapyinnoncirrhotichepatitisbpatientswithpriorsevereacuteexacerbation AT shouwulee cessationofnucleostideanaloguetherapyinnoncirrhotichepatitisbpatientswithpriorsevereacuteexacerbation AT hsinjutsai cessationofnucleostideanaloguetherapyinnoncirrhotichepatitisbpatientswithpriorsevereacuteexacerbation AT tengyulee cessationofnucleostideanaloguetherapyinnoncirrhotichepatitisbpatientswithpriorsevereacuteexacerbation
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Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation

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