NA therapy can be withdrawn in noncirrhotic CHB patients

Termination of nucleos(t)ide analogue (NA) therapy is feasible in noncirrhotic patients negative for the hepatitis B e-antigen (HBeAg), a recent study has found. In particular, those with low baseline HB surface antigen (HBsAg) levels see better outcomes after NA withdrawal.

The study included 27 HBeAg-negative chronic hepatitis B (CHB) patients without cirrhosis. All had achieved complete viral suppression for >3 years and were subsequently taken off of NA therapy. Serum samples and measurements were conducted at baseline and at 3, 6, 12, 18, and 24 months. Functional cure (HBsAg loss) and virological control were the primary efficacy endpoints.

Twenty-two of the 27 participants remained off-therapy after a median follow-up of 34 months. Of these, eight (30 percent of the total cohort) achieved functional cure, with a median time to HBsAg clearance of 25 weeks. Five of these eight cured patients also showed detectable levels of anti-HB antibodies.

Patients who had achieved functional cure had lower HBsAg levels at baseline; in particular, concentrations tended to be ≤1,000 IU/mL in these participants. In turn, baseline HBsAg was also correlated with intrahepatic viral RNA and DNA, the levels of which were suppressed in patients who were functionally cured.

Moreover, a higher baseline frequency of CD8+ T cells against the virus was associated with better viral control off-treatment.

“NA therapy can be discontinued in a high proportion of CHB patients without cirrhosis,” the researchers said. “Our comprehensive study provides in-depth data on virological and immunological factors that can help guide individualized therapy in patients with CHB.”