Longer Antiviral Treatment Urged after Seroconversion to Prevent Relapse

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

Current medical guidelines suggest patients may stop taking antivirals once they lose HBeAg, 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 recommends 11 months or longer of “consolidation” treatment to prevent resurgence of viral loads.

Chinese researcher followed 162 formerly HBeAg-positive patients who met the standard set by treatment guidelines to stop antiviral treatment. They were divided into four groups, with one group stopping treatment after six months as directed by the guidelines. The remaining three groups continued to take antivirals for longer periods. The patients who extended their "consolidation therapy" beyond six months had relapse rates much lower than those who stopped after six months. "Consolidation therapy with antivirals after HBeAg seroconversion should be further prolonged," researchers wrote.

An unrelated report published in the June issue of Hepatology examined whether the current antiviral "stopping rule" was effective in 95 patients who were already HBeAg-negative (39 of whom had cirrhosis).

The HBeAg-negative patients were treated on average for 721 days with the antiviral entecavir (Baraclude) before stopping treatment after achieving low viral load (HBV DNA) and healthy alanine aminotransferase (ALT) levels, which indicate no liver damage. They were monitored every three months after stopping treatment.

Within one year of stopping antivirals, 45.3% of patients relapsed and developed elevated ALT and HBV DNA levels. Among cirrhotic patients, 43.6% relapsed and one (2.6%) developed severe liver damage. The time until relapse was on average 230 days.
Patients with lower viral load (less than 200,000 IU/mL) at start of treatment suffered fewer relapses.

These researchers suggested the stopping rule for HBeAg-negative patients with lower viral loads at baseline was adequate, but HBeAg-negative patients with higher viral loads should receive at least 64 weeks of "consolidation" treatment instead of just six months of treatment.
 
Source 1: "Relapse Rate and Associated-Factor of Recurrence after Stopping NUCs Therapy with Different Prolonged Consolidation Therapy in HBeAg Positive CHB Patients," by Pan X, Zhang K, Yang X et al. PLoS One. 2013 Jul 3;8(7):e68568. www.ncbi.nlm.nih.gov/pubmed/23844222

Source 2: "Off therapy durability of response to Entecavir therapy in HBeAg-negative chronic hepatitis B patients," by Jeng W, Sheen I, Chen Y et al. Hepatology. 2013 Jun 6. doi: 10.1002/hep.26549. www.ncbi.nlm.nih.gov/pubmed/23744454

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