Withdrawal of antiviral treatment in Hepatitis B

15 July, 2023

Chronic hepatitis B affects over 250 million people worldwide and can progress to cirrhosis and liver cancer.

There are effective treatments with antiviral drugs (entecavir, tenofovir,…) that suppress the multiplication of the B virus and can prevent the progression of the disease. However, even with administration of these drugs for years, complete cure (hepatitis B virus surface antigen [HBsAg] negative) is achieved in only 1% of patients. For this reason, it is necessary to treat patients for life, with the possible side effects (loss of bone density, kidney disease,…) that it entails.

Two papers have been published in which the evolution of hepatitis B after discontinuation of treatment with antiviral drugs is evaluated. The first included 158 Caucasian patients with hepatitis B (anti-HBe positive and HBeAg negative) receiving antiviral treatment and who had responded to it for at least 4 years (normal transaminases and BHV DNA negative). Treatment was interrupted in 79 patients while it was continued in the other 79. Cure (loss of HBsAg) was observed in 10.1% of patients in whom treatment was interrupted and in none of those who continued. A sustained response was maintained for at least 18 months in 14 patients (17.9%) in whom the medication was discontinued. Another 28 patients suffered increased transaminases, returning to normal levels spontaneously in 20 cases, while the other 8 had to be treated again. The most important prognostic factor for the loss of HBsAg was its quantity: the 8 patients who became negative had less than 1000 IU/ml of HBsAg levels at the time of discontinuation of treatment.

In the other study, 102 patients of Asian origin with chronic hepatitis B were included (with similar inclusion criteria to the previous study)  and were divided into two groups of 43 and 49 patients with and without interruption of antiviral treatment, respectively. HBsAg disappearance occurred in 3 (7%) and 2 (4%) of the patients in both groups, with no significant difference.

Contradictory results in both studies

These two studies present conflicting messages. In the first one it is recommended to interrupt the treatment under certain circumstances and in the second it is not. In the opinion of Dr. Carreño and the Foundation’s team of hepatologists, this may be due to the difference in race of the study participants (Caucasian vs. Asian). Therefore, we consider that in Caucasian patients with chronic hepatitis B and HBsAg levels below 1,000 IU/ml, the possibility of interrupting treatment can be evaluated, although periodic follow-up is essential, with monthly analysis for 96 weeks (1.84 years). ) to monitor possible reactivation of the disease.

Te puede interesar