—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
Labels: HBeAg seroconversion, seroconversion, treatment duration, treatment length