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Pooling data to assess risks and benefits of discontinuing nucleos(t)ide analogs in patients with chronic hepatitis B: challenges and opportunities
  1. Yao-Chun Hsu1,2,
  2. Cheng-Hao Tseng1,3,
  3. Tung-Hung Su4,5,
  4. Jia-Horng Kao4,5,
  5. Mindie H Nguyen6,7
  1. 1 School of Medicine, I-Shou University, Kaohsiung, Taiwan
  2. 2 Center for Liver Diseases, E-Da Hospital, Kaohsiung, Taiwan
  3. 3 Gastroenterology and Hepatology, E-Da Cancer Hospital, Kaohsiung, Taiwan
  4. 4 Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  5. 5 Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
  6. 6 Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
  7. 7 Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
  1. Correspondence to Dr Yao-Chun Hsu, Center for Liver Diseases, E-Da Hospital, Kaohsiung 824, Taiwan; holdenhsu{at}

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We read with great interest the meta-analysis by Hall et al,1 and congratulate the authors on their accomplishment of such a comprehensive literature review. However, we would like to raise a few concerns to caution readers on the study limitations regarding their data aggregation and analysis. First, the analysis included several studies that appeared duplicate considerably in their patient populations and thus similar data from the same patients were counted more than once (table 1).2 For example, four publications from the same study group at the Kaohsiung Chang Gung Memorial Hospital in Taiwan were included to calculate the cumulative incidence of clinical relapse after discontinuation of entecavir or tenofovir. The latest and also largest study by Ma et al 3 presumably contained data from most, if not all, patients enrolled in the three earlier studies. Second, some studies were composed of highly selected participants whose features differed significantly from those of a general population of patients with chronic hepatitis …

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  • Contributors Drafting of the manuscript was done by Y-CH. Data curation was performed by C-HT. Editing and revision of the manuscript were done by all the authors. All authors confirmed the manuscript and accepted the responsibility for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Y-CH has received research support from Gilead Sciences, has received lecture fees from Abbvie, Bristol-Myers Squibb, Gilead Sciences and Novartis, and has served as an advisory committee member for Gilead Sciences. C-HT has received lecture fees from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Bayer and Roche. T-HS reports nothing to declare. J-HK reports nothing to declare. MHN has received research support from Pfizer, Gilead Sciences, Enanta, Vir Biotech, Glycotests, B. K. Kee Foundation, Helio Health and the National Cancer Institute and has served as an advisory board member or consultant for Gilead, Intercept, Novartis, Eisai, Bayer, Exact Science, Laboratory of Advanced Medicine, Spring Bank and Janssen.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.