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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: Lai, Chia-Yeh, Yang, Sheng-Shun, Lee, Shou-Wu, Tsai, Hsin-Ju, Lee, Teng-Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584579/
https://www.ncbi.nlm.nih.gov/pubmed/34768403
http://dx.doi.org/10.3390/jcm10214883
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author Lai, Chia-Yeh
Yang, Sheng-Shun
Lee, Shou-Wu
Tsai, Hsin-Ju
Lee, Teng-Yu
author_facet Lai, Chia-Yeh
Yang, Sheng-Shun
Lee, Shou-Wu
Tsai, Hsin-Ju
Lee, Teng-Yu
author_sort Lai, Chia-Yeh
collection PubMed
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%; p = 0.045) and SAE recurrence (25.91%, 95% CI: 10.91–40.91% vs. 1.04%, 95% CI: 0–3.07%; p < 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%; p = 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.
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spelling pubmed-85845792021-11-12 Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation Lai, Chia-Yeh Yang, Sheng-Shun Lee, Shou-Wu Tsai, Hsin-Ju Lee, Teng-Yu J Clin Med Article 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%; p = 0.045) and SAE recurrence (25.91%, 95% CI: 10.91–40.91% vs. 1.04%, 95% CI: 0–3.07%; p < 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%; p = 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. MDPI 2021-10-23 /pmc/articles/PMC8584579/ /pubmed/34768403 http://dx.doi.org/10.3390/jcm10214883 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lai, Chia-Yeh
Yang, Sheng-Shun
Lee, Shou-Wu
Tsai, Hsin-Ju
Lee, Teng-Yu
Cessation of Nucleos(t)ide Analogue Therapy in Non-Cirrhotic Hepatitis B Patients with Prior Severe Acute Exacerbation
title 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_short 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
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584579/
https://www.ncbi.nlm.nih.gov/pubmed/34768403
http://dx.doi.org/10.3390/jcm10214883
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