Friday, July 12, 2013

Longer antiviral treatment needed to prevent relapse

Current medical guidelines suggest patients can stop taking antivirals once they lose the hepatitis B “e” antigen, develop “e” antibodies and achieve undetectable viral load for at least six months. But a new study published in the July issue of PLoS One finds that 11 months or longer of antiviral treatment is really needed to keep these patients from relapsing with resurging viral loads.

—Christine. M. Kukka, Project Manager, HBV Advocate

Source: http://www.ncbi.nlm.nih.gov/pubmed/23844222
Full text of the study is found at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0068568

Abstract:

Relapse Rate and Associated-Factor of Recurrence after Stopping NUCs Therapy with Different Prolonged Consolidation Therapy in HBeAg Positive CHB Patients.
Pan X, Zhang K, Yang X, Liang J, Sun H, Li X, Zou Y, Xu Q, An G, Li G, Xu Q.
Department of Infectious Diseases, The 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

BACKGROUND:
Many chronic hepatitis B (CHB) patients recur after off-therapy and have to accept prolonged consolidation therapy with NUCs. We investigated the rate of HBV relapse after stopping NUCs therapy with different time period of prolonged consolidation therapy in HBeAg positive CHB patients, and analyzed the associated-factor of recurrence.

METHODS:
We recruited 162 HBeAg-positive CHB patients who met the standard of stopping NUCs therapy recommended by the 2005 APASL. Patients in group A, without the prolonged consolidation therapy, were as controls. Patients in group B were divided into 3 subgroups (group B1, 7 (range 3-11) months of the prolonged consolidation therapy; group B2, 17 (range 13-20) months of the prolonged consolidation therapy; group B3, 28 (range 25-34) months of the prolonged consolidation therapy). Virologic relapse was defined as an increase in serum HBV DNA to >103copies/ml after off-therapy.

RESULTS:
One hundred and thirty-six patients (group A, 40 patients; group B1, 54 patients; group B2, 23 patients; group B3, 19 patients) were eligible for this study. The cumulative rates of relapse in group B at 6 months and 48 months were 29.2%, 41.7% after off-therapy, respectively. The cumulative rates of relapse in group B were statistically lower than that in group A at the same time periods. The cumulative rate of relapse in group B3 or group B2 was statistically lower than that in group B1, respectively. On multivariate analysis by Cox's proportional hazard model, age at off-therapy, baseline ALT and the different time period of the prolonged consolidation therapy were associated with the relapse of HBV after off-therapy.

CONCLUSIONS:
Consolidation therapy with NUCs after HBeAg seroconversion should be further prolonged. Age at off-therapy, ALT at baseline and the time period of the prolonged consolidation therapy could provide information to direct anti-viral therapy.

PLoS One. 2013 Jul 3;8(7):e68568. Print 2013.

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