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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/08  
 
  2018 Aug;68(2):425-434.  
  doi: 10.1002/hep.29640.  
 
  Incidence and predictors of hepatitis B surface antigen seroclearance after cessation of nucleos(t)ide analogue therapy in hepatitis B e antigen-negative chronic hepatitis B.  
 
  Jeng WJ, Chen YC, Chien RN, Sheen IS, Liaw YF  
  https://www.ncbi.nlm.nih.gov/pubmed/29108132  
 
 

Abstract
 

Hepatitis B surface antigen (HBsAg) loss is a rare event during nucleos(t)ide analogue (Nuc) therapy. Limited data suggest that stopping Nuc therapy may increase HBsAg loss rate in hepatitis B e antigen-negative patients. A large study was conducted to investigate this issue in more detail. Of the 1,075 hepatitis B e antigen-negative patients treated with Nuc for a median of 156 (61-430) weeks, 5 showed HBsAg seroclearance during treatment at an estimated annual incidence of 0.15%. Of the patients who remained HBsAg-seropositive, 691 (52.3 years old, 86% male, 44.6% cirrhosis) had stopped Nuc therapy by the Asian-Pacific Association for the Study of the Liver stopping rule and then were prospectively followed up. Baseline and on-treatment clinical and viral features, treatment duration, consolidation duration, time to undetectable hepatitis B virus DNA, time to normal alanine aminotransferase, end-of-treatment HBsAg, and HBsAg log reduction were compared between patients with and without HBsAg seroclearance after end of treatment. During a median off-therapy follow-up period of 155 (2-614) weeks, HBsAg seroclearance was confirmed in 42 patients. The 6-year cumulative incidence was 13% with an estimated annual incidence of 1.78%. Cox regression analysis showed that shorter time to undetectable hepatitis B virus DNA (<12 weeks), greater HBsAg reduction during therapy (>1 log10 ), lower end-of-treatment HBsAg level (<100 IU/mL), patients with sustained response, and relapsers not retreated were factors for off-therapy HBsAg seroclearance.

CONCLUSION:

The incidence of HBsAg seroclearance after stopping Nuc was much higher than that during therapy and highest in patients without virologic and clinical relapse; patients with clinical relapse who remained untreated had a 7.34 times higher incidence of HBsAg clearance than those who received retreatment, suggesting that transient untreated clinical relapse may drive sufficient immune control to functional cure. (Hepatology 2017).

 
Question posée
 
L’arrêt des analogues nucléos(t)iques (NUC) augmente-t-il le taux de perte de l’AgHBs chez les patients AgHBe négatif ?
 
Question posée
 
L’incidence cumulée de séroclairance de l’AgHBs est de 13% chez les patients ayant stoppé les NUC et de seulement 3% chez ceux ayant continué les NUC. L’incidence de séroclairance de l’AgHBs est plus élevée chez les patients ayant une SVR et chez ceux chez qui les NUC n’ont pas été repris alors même qu’ils présentaient une rechute clinique.
 
Commentaires

Cette étude souligne le rôle de l’activation du système immun dans la séroclairance de l’AgHBs. Les patients doivent être cependant très bien sélectionnés et il est nécessaire d’avoir d’autre études car même si les auteurs soulignent que les décompensations de cirrhose ont été rares et que le taux de CHC n’a pas augmenté, un patient est décédé dans le groupe stop sans reprise de NUC.

 
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