دورية أكاديمية
Stopping Nucleos(t)ide Analogues in Chronic Hepatitis B Using HBsAg Thresholds: A Meta-Analysis and Meta-Regression.
| العنوان: | Stopping Nucleos(t)ide Analogues in Chronic Hepatitis B Using HBsAg Thresholds: A Meta-Analysis and Meta-Regression. |
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| المؤلفون: | Lim SG; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore. Electronic address: mdclimsg@nus.edu.sg., Teo AE; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Chan ES; Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation Singapore, Singapore; Cochrane Singapore, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore., Phyo WW; Division of Gastroenterology and Hepatology, National University Health System, Singapore., Chen DHY; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Hargreaves CA; Data Analytics Consulting Centre, Faculty of Science, National University of Singapore, Singapore. |
| المصدر: | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Jun 12. Date of Electronic Publication: 2024 Jun 12. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article; Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: W.B. Saunders for the American Gastroenterological Association Country of Publication: United States NLM ID: 101160775 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1542-7714 (Electronic) Linking ISSN: 15423565 NLM ISO Abbreviation: Clin Gastroenterol Hepatol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : W.B. Saunders for the American Gastroenterological Association, 2003- |
| مستخلص: | Background and Aims: Recommendations for stopping nucleoside analogue (NA) therapy in hepatitis B e antigen-negative chronic hepatitis B (CHB) are unclear. End-of-treatment quantitative hepatitis B serum antigen (EOTqHBsAg) thresholds <100 IU/mL or <1000 IU/mL have been proposed as stopping criteria, which we assessed by meta-analysis and meta-regression. Methods: We searched PubMed, EMBASE, and conference abstracts for studies of hepatitis B e antigen-negative CHB NA discontinuation. Extracted studies were analyzed for risk of bias, pooled risk of hepatitis B serum antigen (HBsAg) loss, virological relapse (VR), and biochemical relapse (BR). Significant heterogeneity (I 2 ) was addressed by subgroup analysis and random-effects meta-regression with known important covariates, including EOTqHBsAg thresholds, ethnicity, duration of therapy, and follow-up. Results: We found 24 articles (3732 subjects); 16 had low and 8 had moderate risk of bias. The pooled risks of HBsAg loss, VR, and BR for stopping therapy at EOTqHBsAg <100 IU/mL were 41.8%, 33.4%, and 17.3%, respectively, vs 4.6%, 72.1%, and 34.6%, respectively, for EOTqHBsAg ≥100 IU/mL. The pooled risks of HBsAg loss, VR, and BR for stopping therapy at EOTqHBsAg <1000 IU/mL were 22.0%, 52.7%, and 15.9%, respectively, vs 3.4%, 63.8%, and 26.4%, respectively, for EOTqHBsAg ≥1000 IU/mL. Multivariable analysis for HBsAg loss showed that ethnicity, follow-up duration, and EOTqHBsAg <100 IU/mL and ≥100 IU/mL explained 85% of the variance in heterogeneity; Asians with EOTqHBsAg <100 IU/mL had 28.2%, while non-Asians with EOTqHBsAg <1000 IU/mL had 38.4% HBsAg loss. Multivariable analysis showed EOTqHBsAg <100 IU/mL and ≥100 IU/mL and other covariates only explained 43% and 63% of the variance in heterogeneity for VR and BR, respectively, suggesting that other factors are also important for relapse. Conclusions: While EOTqHBsAg thresholds, ethnicity, and follow-up duration strongly predict HBsAg loss, this is not true for VR and BR, hence stopping NA therapy should be considered cautiously. (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Antiviral Therapy; Cessation; Discontinuation; Flare; Functional Cure; Relapse |
| تواريخ الأحداث: | Date Created: 20240613 Latest Revision: 20240712 |
| رمز التحديث: | 20240713 |
| DOI: | 10.1016/j.cgh.2024.05.040 |
| PMID: | 38871150 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1542-7714 |
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| DOI: | 10.1016/j.cgh.2024.05.040 |