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Original research
Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: a nationwide multicentre study
  1. Minseok Albert Kim1,
  2. Seung Up Kim2,
  3. Dong Hyun Sinn3,
  4. Jeong Won Jang4,
  5. Young-Suk Lim5,
  6. Sang Hoon Ahn2,
  7. Jae-Jun Shim6,
  8. Yeon Seok Seo7,
  9. Yang Hyun Baek8,
  10. Sang Gyune Kim9,
  11. Young Seok Kim9,
  12. Ji Hoon Kim10,
  13. Won Hyeok Choe11,
  14. Hyung Joon Yim12,
  15. Hyun Woong Lee13,
  16. Jung Hyun Kwon14,
  17. Sung Won Lee15,
  18. Jae Young Jang16,
  19. Hwi Young Kim17,
  20. Yewan Park3,
  21. Gi-Ae Kim6,
  22. Hyun Yang4,
  23. Han Ah Lee7,
  24. Myeongseok Koh8,
  25. Young-Sun Lee10,
  26. Minkoo Kim12,
  27. Young Chang16,
  28. Yoon Jun Kim1,
  29. Jung-Hwan Yoon1,
  30. Fabien Zoulim18,
  31. Jeong-Hoon Lee1
  1. 1Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
  2. 2Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  3. 3Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  4. 4Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  5. 5Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  6. 6Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
  7. 7Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
  8. 8Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
  9. 9Department of Internal Medicine, Bucheon Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
  10. 10Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
  11. 11Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea
  12. 12Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
  13. 13Department of Internal Medicine and Yonsei Liver Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  14. 14Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Incheon, South Korea
  15. 15Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, Catholic University of Korea, Bucheon, South Korea
  16. 16Department of Internal Medicine, Seoul Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
  17. 17Department of Inernal Medicine, Ewha Women's University College of Medicine, Seoul, South Korea
  18. 18Cancer Research Centre of Lyon, INSERM U1052, Lyon University, Hospices Civils de Lyon, Lyon, France
  1. Correspondence to Professor Jeong-Hoon Lee, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea; pindra{at}empal.com

Abstract

Objective Direct comparison of the clinical outcomes between nucleos(t)ide analogue (NA) discontinuation versus NA continuation has not been performed in patients with chronic hepatitis B who achieved HBsAg-seroclearance. Whether NA discontinuation was as safe as NA continuation after NA-induced surface antigen of HBV (HBsAg) seroclearance was investigated in the present study.

Designs This multicentre study included 276 patients from 16 hospitals in Korea who achieved NA-induced HBsAg seroclearance: 131 (47.5%) discontinued NA treatment within 6 months after HBsAg seroclearance (NA discontinuation group) and 145 (52.5%) continued NA treatment (NA continuation group). Primary endpoint was HBsAg reversion and secondary endpoints included serum HBV DNA redetection and development of hepatocellular carcinoma (HCC).

Results During follow-up (median=26.9 months, IQR=12.2–49.2 months), 10 patients (3.6%) experienced HBsAg reversion, 6 (2.2%) showed HBV DNA redetection and 8 (2.9%) developed HCC. Compared with NA continuation, NA discontinuation was not associated with HBsAg reversion in both univariable (HR=0.45, 95% CI=0.12 to 1.76, log-rank p=0.24) and multivariable analyses (adjusted HR=0.65, 95% CI=0.16 to 2.59, p=0.54). The cumulative probabilities of HBsAg reversion at 1, 3 and 5 years were 0.8%, 2.3% and 5.0% in the NA discontinuation group, and 1.5%, 6.3% and 8.4% in the NA continuation group, respectively. NA discontinuation was not associated with higher risk of either HBV redetection (HR=0.83, 95% CI=0.16 to 4.16, log-rank p=0.82) or HCC development (HR=0.53, 95% CI=0.12 to 2.23, log-rank p=0.38).

Conclusion The discontinuation of NA was not associated with a higher risk of either HBsAg reversion, serum HBV DNA redetection or HCC development compared with NA continuation among patients who achieved HBsAg seroclearance with NA.

  • HBV DNA redetection
  • hepatocellular carcinoma
  • HBsAg
  • antivirals
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Footnotes

  • MAK, SUK and DHS are joint first authors.

  • Presented at A version of this study was presented as an oral presentation at The Liver Meeting 2019 (Boston, Massachusetts, USA) held by the AASLD, of which abstract was published in Hepatology. Hepatology 2019;70(S1):129A–130A.

  • Correction notice This article has been corrected since it published Online First. The text in table 1 has been indented correctly and the footnote removed.

  • Contributors J-HL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: J-HL. Provision of study materials or patients: SUK, DHS, JWJ, Y-SL, SHA, J-JS, YSS, YHB, SGK, YSK, JHK, W-HC, HJY, HWL, JHK, SWL, JYJ, HYK, YJK, J-HY and J-HL. Collection and assembly of data: MAK, YP, G-AK, HY, HAL, M-SK, Y-SL, MK and YC. Data analysis and interpretation: MAK, J-HL and FZ (data interpretation). Manuscript writing: MAK and J-HL. Revision of manuscript: MAK, FZ and J-HL. Final approval of manuscript: All authors.

  • Funding The trial was supported by grants from Liver Research Foundation of Korea as part of Bio Future Strategies Research Project, Seoul National University Hospital Research Fund (grant number 03-2016-0380), and from the National Research Foundation of Korea (NRF) grants funded by the Korea government (MSIP) (grant number NRF-2019R1A2C2010311).

  • Competing interests SUK reports receiving grants from Yuhan Pharmaceuticals, and lecture fees from Bristol-Myers Squibb, Gilead Science and Yuhan Pharmaceuticals; JWJ reports receiving research grants from Yuhan Pharmaceuticals and lecture fees from Abbie, Bristol-Myers Squibb, Gilead Science and MSD Korea, and serving as an advisory board member of Abbie, Gilead Science and MSD Korea; Y-SL reports receiving research grants from Bayer HealthCare Pharmaceuticals and Gilead Science, and serving as an advisory board member of Bayer HealthCare Pharmaceuticals and Gilead Science; HWL reports receiving lecture fee from Abbie, Chongkundang Pharmaceuticals, Dong-A ST Pharmaceuticals, Ildong Pharmaceuticals and Yuhan Pharmaceuticals; JHK, lecture fee from Abbie, Bristol-Myers Squibb, Gilead Science, and MSD Korea; SWL reports receiving research grants from Yuhan Pharmaceuticals, lecture fees from Abbie, Bristol-Myers Squibb, Bukwang Pharmaceuticals, Daewoong Pharmaceuticals, MSD Korea and Yuhan Pharmaceuticals, and serving as an advisory board member of Eisai and Gilead Science; JYJ reports receiving research grants from Bukwang and Yuhan Pharmaceuticals, lecture fees from Bristol-Myers Squibb, Bukwang Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Celltrion, Daewoong Pharmaceuticals, Gilead Science and Yuhan Pharmaceuticals; YJK reports receiving research grants from Bristol-Myers Squibb, Roche, JW Creagene, Bukwang Pharmaceuticals, Handok Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals and Pharmaking, and lecture fees from Bayer HealthCare Pharmaceuticals, Gilead Science, MSD Korea, Yuhan Pharmaceuticals, Samil Pharmaceuticals, CJ Pharmaceuticals, Bukwang Pharmaceuticals and Handok Pharmaceuticals; J-HY reports receiving research grant from Bayer HealthCare Pharmaceuticals, Bukwang Pharmaceuticals and Daewoong Pharmaceuticals, and J-HL reports receiving lecture fees from GreenCross Cell, Daewoong Pharmaceuticals and Gilead Korea.

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

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board of each participating centre.

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

  • Data availability statement No data are available.

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