Discontinuation of nucleos(t)ide analogue therapy for chronic hepatitis B correlated with risk for clinical relapse based on total serum level of HBV core antibodies after 2.5 years of follow-up, according to recently published data.
“Studies have suggested that the recognition and targeting of [HBV core antibodies (anti-HBc)] by the adaptive immune system play an important role in viral clearance,” Heng Chi, MD, from the Erasmus MC University Medical Center in Rotterdam, the Netherlands, and colleagues wrote. “Our results suggest that a high level of anti-HBc may be correlated with a more enhanced HBV-specific immune response.”
The study comprised 100 patients who were positive for HBV surface antigen, negative for HBV e-antigen, and had undetectable HBV DNA at the time of nucleos(t)ide analogue (NA) discontinuation. During a median follow-up of 2.5 years, no patients developed decompensated cirrhosis or hepatocellular carcinoma.
During follow-up, 39 patients experienced clinical relapse and 76 patients experienced virologic relapse with HBV DNA higher than 2,000 IU/mL. Six patients experienced HBsAg seroclearance after NA discontinuation for a cumulative rate of 10% at year 4.
Multivariate analysis showed that younger age (HR = 1.06; 95% CI, 1.01-1.11), low end-of-treatment HBsAg levels (HR = 1.71; 95% CI, 1.05-2.81), and high end-of-treatment anti-HBc levels (HR = 0.31; 95% CI, 0.15-0.65) correlated significantly with a reduced risk for clinical relapse.
Further stratification of end-of-treatment anti-HBc levels showed that a level of 1,000 IU/mL or higher correlated with the lowest risk for clinical relapse (21% at year 4; P < .05) compared with levels between 100 IU/mL and 999 IU/mL (50% at year 4). In contrast, patients with anti-HBc levels less than 100 IU/mL had the highest risk for clinical relapse (85% at year 4; P < .05).
“Anti-HBc alone or in combination with HBsAg appear to play an important role in the selection of patients who are suitable for treatment discontinuation, and therefore warrant further validation,” the researchers concluded.
By Talitha Bennett