Can we stop nucleoside analogues before HBsAg loss?
Most of the current guidelines and the existing data suggest that long term therapy with nucleos(t)ide analogue(s) [NA(s) may be stopped in carefully selected chronic hepatitis B patients who remain HBsAg positive. In particular, NA(s) may be discontinued in such patients without pre existing cirrhosis who achieved long term on therapy virological remission >12 months of HBeAg seroconversion and HBV DNA undetectability for initially HBeAg positive cases; =3 years of HBV DNA undetectability for HBeAg negative cases) and are expected to remain under close follow up after NA(s) discontinuation. The majority of patients will develop post NA(s) virological relapses and a proportion of them will have biochemical relapses and occasionally flares, but prompt retreatment can reintroduce remission. No reliable predictor(s) of post NA(s) relapses have been identified so far. HBsAg loss develops in a progressively increasing proportion of chronic hepatitis B patients who discontinue NA(s) with HBsAg loss rates being higher in Caucasian patients with HBeAg negative chronic hepatitis B. Follow up at least every 3 months for the first year seems to be appropriate for all chronic hepatitis B patients who discontinue NA(s) while HBeAg negative patients need to be followed more closely (monthly) during the first 3 months. Predefined criteria for retreatment are quite important, and the best candidates for retreatment are probably the patients with persistent =3 months) liver disease activity and those with severe flares.
Journal of viral hepatitis