Durability Of Effectiveness After Cessation Of Nucleotide Analogue Treatment In Patients With Chronic Hepatitis B

Objective: To investigate the correlated clinic factors of durabilityafter cessation of nucleotide analogue treatment in HBeAg-positive andHBeAg-negative chronic hepatitis B(CHB) patients by retrospectivemethod.Methods:315patients subjecting to nucleotide analoguemonotherapy for on less than1year and biochemistry、virologywere complete response. Hepatic biochemical parameters, serology,HBV-DNA testing,follow-up were detemlined after1．3．6．12monthsafter cessation of nucleotide analogue respectively．The relapse wasdefined as HBVDNA≥103copies／ml，which was the end point ofstudy．No recurrence patients were followed for up to1year. Compare tothe relapse rates of CHB patinents with up or not up to withdrawalcriteria. To divide the HBeAg-positive and HBeAg-negative CHBpatients who up to withdrawal criteria to nucleotide analoguetreatment into two groups, according to whether the curative effect wasconsolidated after the withdrawal of nucleotide analogue therapy for1year. To compare the two groups correlated clinic factors.Result: The relapse rate was46.2%(54/117) and(152/182)83.5%in117CHB patients of up to withdrawal criteria and182patients of not up to after withdrawal1year. The cumulativerate of relapse after1、3、6、12months after withdrawal criteria tonucleotide analogue treatment were0%，24.4%、30.5%，39.0%and8.6%，37.1%,51.4%，62.9%in HBeAg-positive and HBeAg-negative CHBpatients respectively；The cumulative rate of relapse after1、3、6、12monthsafter not up to withdrawal criteria to nucleotide analogue treatmentwere22.5%、45.1%、58.5%、85.2%and5%、35.0%、55.0%、71.5%in HBeAg-positive and HBeAg-negative CHB patients respectively.The relapse rate is still high with up to withdrawal criteria，Therelapse rate is higher with not up to the withdrawal criteria.Thedurabiltity of effectiveness of HBeAg-negative patients was lower than thatof the HBeAg-positive ones. Our results might suggest that the highrelapse rates after achieving sustained virologic response showed nodifference of durability regardless of the type of oral high potencyantiviral agent. In multivariate analysis, nine variables (age,gender,pretreatment ALT and AST, pretreatment serum HBV-DNA,additional treatment after undetect-able HBVDNA, additional treatmentafter HBeAg serocon-version and total duration of nucleotide analoguetreatment) entered the Cox proportional hazard model. Age, pretreatment ALT associated with withdrawal recurrence.Conlusion: The relapse rate is high of nucleotide analogstreatment after withdrawal criteria, The relapse rate is higher not up to thewithdrawal criteria. There is no difference of durability regardless ofthe type of oral high potency antiviral agent. Age, pretreatment ALTassociated with withdrawal recurrence. The age less than35and thebaseline ALT more than upper limits of normal in HBeAg-positive CHBpatients could got a better durability of effectiveness after withdrawalcriteria. The durabiltity of effectiveness of HBeAg-negative patients waslower than that of the HBeAg-positive ones. The ideal endpoint HBsAgdisappeared of HBeAg negative CHB patients.