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Fong TL, Tien A, Jo KJ, Chu D, Cheung E, Mena EA, Phan QQ, Yu AS, Mohammed W, Velasco A, LeDuc VH, Nguyen N, Han SB, Chang M, Bae HS, Cho YW, Tong MJ, Cooper SL. Durability of Hepatitis B e Antigen Seroconversion in Chronic Hepatitis B Patients Treated with Entecavir or Tenofovir. Dig Dis Sci 2015; 60:3465-72. [PMID: 26138653 PMCID: PMC4803449 DOI: 10.1007/s10620-015-3775-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/17/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied. METHODS We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment. RESULTS Only 4 (7%) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24%) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69%) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62%) remained HBeAg negative/anti-HBe positive, 12 (32%) became HBeAg positive, and 2 (5%) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse. CONCLUSIONS Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.
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Affiliation(s)
- Tse-Ling Fong
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2/F, Los Angeles, CA, 90033, USA.
| | - Andy Tien
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Kahee J Jo
- Liver Disease and Transplant Program, California Pacific Medical Center, San Francisco, CA, USA
| | | | - Eddie Cheung
- Division of Gastroenterology, University of California Davis, Davis, CA, USA
- Private Practice, Oakland, CA, USA
| | - Edward A Mena
- Liver Center, Huntington Research Institute, Pasadena, CA, USA
| | | | | | - Wafa Mohammed
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Andrew Velasco
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Vinh-Huy LeDuc
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Nickolas Nguyen
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Steven-Bui Han
- Division of Gastroenterology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mimi Chang
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Ho S Bae
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Yong-Won Cho
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
| | - Myron J Tong
- Liver Center, Huntington Research Institute, Pasadena, CA, USA
| | - Stewart L Cooper
- Liver Disease and Transplant Program, California Pacific Medical Center, San Francisco, CA, USA
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