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Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV

  • Hepatitis B (J Lim, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the evidence for stopping antiviral therapy with nucleos(t)ide analogues (NA) in patients with chronic hepatitis B.

Recent Findings

HBsAg loss is usually stable even without anti-HBs seroconversion after stopping NA therapy. About 50% of HBeAg-positive patients who have achieved anti-HBe seroconversion and have stopped NA therapy remain in virological remission. Consolidation therapy increases the response rate. In HBeAg-negative hepatitis, stable virological remission is documented in 30% after NA discontinuation. Interestingly, some studies document unexpectedly high long-term HBsAg loss rates after stopping therapy.

Summary

Evidence supports NA discontinuation, especially after HBsAg seroclearance. In HBeAg-positive patients, NA can be stopped 12 months after anti-HBe seroconversion but severe flares have to be considered. NA discontinuation is also possible in selected HBeAg-negative patients if close monitoring can be guaranteed. The high rate of HBsAg loss needs further evaluation.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany

    Maximilian Wübbolding, Markus Cornberg & Christoph Höner zu Siederdissen

  2. German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Carl-Neuberg Strasse 1, Hannover, Germany

    Markus Cornberg

  3. Centre for Individualised Infection Medicine (CIIM), Feodor-Lynen-Straße 15, Hannover, Germany

    Markus Cornberg

  4. Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany

    Markus Cornberg

  5. Cluster of Excellence Resolving Infection Susceptibility (RESIST; EXC), Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany

    Markus Cornberg

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  1. Maximilian Wübbolding
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Correspondence to Markus Cornberg.

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Conflict of Interest

Maximilian Wübbolding declares no potential conflicts of interest. Markus Cornberg reports personal fees for lectures and advisory boards from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag (Data Safety Board), Roche, Merck (MSD), Biogen, Falk Foundation, Boehringer Ingelheim, Siemens, and Spring Bank. Dr. Cornberg reports a grant from Roche. Christoph Höner zu Siederdissen reports travel grants from Gilead Sciences and Novartis.

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Wübbolding, M., Cornberg, M. & Höner zu Siederdissen, C. Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV. Curr Hepatology Rep 18, 512–521 (2019). https://doi.org/10.1007/s11901-019-00502-z

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