학술논문
Plenary Session 1 : PS-1-6 ; Hepatitis B surface antigen level can predict off-treatment sustained virologic response in chronic hepatitis B patients treated with nucleos(t)ide analogues
Document Type
Article
Author
Source
춘·추계 학술대회(The Liver Week). Jun 30, 2012 2012(1):5
Subject
Language
Korean
Abstract
Background: Current guidelines suggest the criteria for discontinuation of nucleos(t)ide analogues (NA) in selected patients. However treatment induced virological response is not permanent. Aim of our study is to evaluate the clinical significance of HBsAg titer in predicting sustained virologic response after NA therapy discontinuation. Methods: From Jun 1998 to Dec 2010, medical record of 81 chronic hepatitis B patients who discontinued NA was analyzed retrospectively. Sustained virologic response (SVR) was arbitrarily defined as undetectable HBV DNA by real-time PCR(with lower limit of detection of 116 copies/mL, 20 IU/mL) persisted more than 12 months after treatment discontinuation. Results: Median age was 51 years, 54 (67%) patients were male, and 50 (62%)patients were HBeAg positive. Median baseline ALT, HBV DNA and HBsAg were 292 IU/mL, 7.1log10 IU/mL and 3.3log10 IU/mL. NA were lamivudine (n=53), adefovir (n=15), lamivudine combined with adefovir (n=4), and entecavir (n=9). Median treatment duration and follow-up period were 26 and 27 months. 11/81 (14%) patients had SVR. The cumulative relapse rates were 37/81 (46%) at 6 months and 42/81 (52%) 12 months after treatment discontinuation. The baseline ALT, HBV DNA and presence of HBeAg were not different between patients with or without SVR. In univariate analysis, age, treatment duration and HBsAg level at treatment discontinuation were different in patients with or without SVR; 51 vs. 43 years, p=0.033; 53 vs. 25 months, p=0.011; 2.1 vs. 3.3log10 IU/mL, p=0.003. In multivariate analysis, only HBsAg level at treatment discontinuation remained as an independent factor associated with SVR (p=0.019). The cutoff value of HBsAg level <2log10 IU/mL was predictive of SVR [(AUROC, 0.991; 95% confidence interval[CI], 0.000-1.000; p<0.05); sensitivity, 100%; specificity, 93%; positive predictive value, 69%; negative predictive value, 100%]. Conclusions: Large proportion of patients treated with oral antivirals relapsed after the treatment discontinuation. In the decision of the treatment discontinuation, HBsAg level <2log10 IU/mL at treatment discontinuation can predict sustained viral suppression in selected patients.