Outcome of nucleos(t)ide analogue cessation in patients with treatment for prevention of or against hepatitis B virus reactivation.

BACKGROUND & AIMS
We retrospectively investigated patients with administration of nucleos(t)ide analogues (NAs) for prevention of or against Hepatitis B virus (HBV) reactivation, and their clinical outcomes after cessation of the NA.


METHODS
We enrolled 180 patients who were positive for HBsAg when they started immunosuppressive therapy or chemotherapy and an NA was administered to prevent HBV reactivation (HBV carrier group), and 82 patients with resolved HBV infection who started administration of an NA after HBV reactivation (de novo HBV group). Cessation of the NA depended on each physician's judgement without definite criteria.


RESULTS
Twenty-seven patients in the HBV carrier group and 22 in the de novo HBV group stopped NA therapy. In the HBV carrier group, 16 patients experienced virological relapse (VR), which was defined as HBV DNA levels ≥20 IU/mL, and 1 with hematological disease had an alanine aminotransferase (ALT) flare after cessation of NA. Of the 16 patients, the NA was reintroduced in 3, whereas, the remaining 13 had low levels of HBV DNA and no ALT flare. In the de novo HBV group, VR occurred in 6 patients, and 1 with hematological disease had an ALT flare after cessation of the NA. The NA was reintroduced in 4 of the 6 patients.


CONCLUSIONS
We may be able to consider to cease NA therapy proactively in HBV carriers and resolved patients with non-hematological disease, if their primary diseases are under remission after completion of immunosuppressive therapy or chemotherapy. However, careful follow-up is necessary after stopping NA therapy. (250 words) This article is protected by copyright. All rights reserved.