Severe Acute Exacerbation After Cessation of Nucleos(t)ide Analog for Chronic Hepatitis B: A Real-World Study of Routine Practice

Yao-Chun Hsu; Jia-Ling Wu; Cheng-Hao Tseng; Mindie H Nguyen; Chih-Wen Lin; Chih-Lung Hung

doi:10.1016/j.cgh.2021.08.037

Severe Acute Exacerbation After Cessation of Nucleos(t)ide Analog for Chronic Hepatitis B: A Real-World Study of Routine Practice

Clin Gastroenterol Hepatol. 2022 Jun;20(6):1413-1415.e3. doi: 10.1016/j.cgh.2021.08.037. Epub 2021 Aug 28.

Authors

Yao-Chun Hsu¹, Jia-Ling Wu², Cheng-Hao Tseng³, Mindie H Nguyen⁴, Chih-Wen Lin⁵, Chih-Lung Hung⁶

Affiliations

¹ Center for Liver Diseases, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine, Fu-Jen Catholic University Hospital, New Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. Electronic address: holdenhsu@gmail.com.
² Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
³ School of Medicine, College of Medicine, I-Shou University, Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan.
⁴ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California.
⁵ School of Medicine, College of Medicine, I-Shou University, Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, Kaohsiung, Taiwan.
⁶ Administrative Center, E-Da Healthcare System, Kaohsiung, Taiwan.

PMID: 34464721
DOI: 10.1016/j.cgh.2021.08.037

Abstract

There is an ongoing debate as to whether patients with chronic hepatitis B (CHB) may discontinue nucleos(t)ide analogue (NA) therapy before seroclearance of hepatitis B surface antigen (HBsAg).¹ Whereas treatment discontinuation may facilitate HBsAg seroclearance and avoid indefinite drug exposure,² reactivation of viral replication almost always follows treatment cessation and frequently leads to clinical flares.³ In patients who encounter withdrawal flares, severe acute exacerbation (SAE) could occur with fatal consequences.⁴ Quantitative knowledge about the risk of SAE is imperative to inform the debate and also the practice.

Publication types

Letter
Research Support, Non-U.S. Gov't

MeSH terms

Antiviral Agents / adverse effects
DNA, Viral
Disease Progression*
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Hepatitis B virus / genetics
Hepatitis B, Chronic*
Humans
Nucleosides / adverse effects
Treatment Outcome
Withholding Treatment

Substances

Antiviral Agents
DNA, Viral
Hepatitis B e Antigens
Hepatitis B Surface Antigens
Nucleosides