Perspectives on stopping nucleos(t)ide analogues therapy in patients with chronic hepatitis B

Tout, Issam; Lampertico, Pietro; Berg, Thomas; Asselah, Tarik

doi:10.1016/j.antiviral.2020.104992

Cited by 29 publications

(39 citation statements)

References 152 publications

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“…Meanwhile, there are studies that the possibility of a functional cure, which is HBsAg loss, can increase as the immune response increases with ALT flare after cessation of NA therapy. Especially, HBsAg loss is reported to increase progressively with a higher probability in Caucasian patients with HBeAg-negative CHB who cease NA therapy [ 244 , 245 , 250 ]. Therefore, cessation of treatment should be carefully decided in consideration of safety and expected off-treatment response.…”

Section: Cessation Of Treatment and Monitoring After Antiviral Treatmentmentioning

confidence: 99%

KASL clinical practice guidelines for management of chronic hepatitis B

2022

Clin Mol Hepatol

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Section: Cessation Of Treatment and Monitoring After Antiviral Treatmentmentioning

confidence: 99%

KASL clinical practice guidelines for management of chronic hepatitis B

2022

Clin Mol Hepatol

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“…Future studies with more diverse and larger patient populations should reconcile the few discrepancies observed among various biomarker correlations and help solidify treatment stopping rules and predictive cutoff values. Measurement and analysis of novel HBV biomarkers will be complemented by the array of host markers that are being investigated to better monitor disease phase, including host genetic markers, micro-RNAs, as well as serum inflammatory and immune markers and cytokines [ 160 , 161 , 162 ]. These markers can be non-invasively measured and so extend the suite of tools for CHB disease activity interpretation.…”

Section: Discussionmentioning

confidence: 99%

“…Genetic markers (single nucleotide polymorphisms) have been associated with the risk of developing cirrhosis, fibrosis or HCC [ 160 ], while host miRNA regulation can indicate the development of fibrosis or HCC [ 161 , 163 ]. Additionally, certain cytokines have been observed to correlate with severity of HBV disease and clinical outcomes [ 162 , 164 , 165 , 166 , 167 ]. Finally, the phenotype and functionality of HBV-specific CD8+ T cells and NK cells have been investigated for predicting HBsAg seroclearance [ 162 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, certain cytokines have been observed to correlate with severity of HBV disease and clinical outcomes [ 162 , 164 , 165 , 166 , 167 ]. Finally, the phenotype and functionality of HBV-specific CD8+ T cells and NK cells have been investigated for predicting HBsAg seroclearance [ 162 ]. Using both host and viral biomarkers together promises to enhance CHB patient management as host markers help define the pathophysiology of the liver and immune state of the patient while viral markers assess the replication level of HBV.…”

Section: Discussionmentioning

confidence: 99%

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Novel Biomarkers of Hepatitis B Virus and Their Use in Chronic Hepatitis B Patient Management

Osiowy

2021

Viruses

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Even though an approved vaccine for hepatitis B virus (HBV) is available and widely used, over 257 million individuals worldwide are living with chronic hepatitis B (CHB) who require monitoring of treatment response, viral activity, and disease progression to reduce their risk of HBV-related liver disease. There is currently a lack of predictive markers to guide clinical management and to allow treatment cessation with reduced risk of viral reactivation. Novel HBV biomarkers are in development in an effort to improve the management of people living with CHB, to predict disease outcomes of CHB, and further understand the natural history of HBV. This review focuses on novel HBV biomarkers and their use in the clinical setting, including the description of and methodology for quantification of serum HBV RNA, hepatitis B core-related antigen (HBcrAg), quantitative hepatitis B surface antigen (qHBsAg), including ultrasensitive HBsAg detection, quantitative anti-hepatitis B core antigen (qAHBc), and detection of HBV nucleic acid-related antigen (HBV-NRAg). The utility of these biomarkers in treatment-naïve and treated CHB patients in several clinical situations is further discussed. Novel HBV biomarkers have been observed to provide critical clinical information and show promise for improving patient management and our understanding of the natural history of HBV.

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“…Retreatment rates range from 22%‐53% with off‐treatment follow‐up periods of ≥1.5 years. ( 53 , 54 ) However, it is important to note that retreatment rates could also be affected by other factors such as reimbursement criteria, especially in Asia. The overall modest rate of HBsAg loss under withdrawal of NAs and the lack of validated predictors of harms (severe flares) and benefits (HBsAg loss or inactive CHB) have led to heterogeneity in the guidelines on when to consider stopping treatment in CHB patients.…”

Section: Novel Approaches Using Approved Therapiesmentioning

confidence: 99%

Aiming for Functional Cure With Established and Novel Therapies for Chronic Hepatitis B

et al. 2021

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Chronic hepatitis B virus (HBV) infection remains difficult to cure due to the persistent, self‐replenishing nature of the viral genome and impaired host immune responses. Current treatment goals for chronic hepatitis B (CHB) are to prevent or significantly delay liver‐related adverse outcomes and death, and two types of treatments are available: nucleos(t)ide analogues (NAs) and interferons (IFNs). NAs effectively suppress HBV replication, and IFNs improve serological response rates, thereby decreasing the risk of adverse outcomes. However, their efficacy in attaining serological responses, especially functional cure (i.e., loss of serum hepatitis B surface antigen), is very limited. Various strategies such as stopping antiviral therapy or combining therapies have been investigated to enhance response, but efficacy is only modestly improved. Importantly, the development of novel direct‐acting antivirals and immunomodulators is underway to improve treatment efficacy and enhance rates of functional cure. The present review provides an overview of the treatment goals and indications, the possibility of expanding indications, and the safety and efficacy of different treatment strategies involving established and/or novel therapies as we continue our search for a cure.

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Perspectives on stopping nucleos(t)ide analogues therapy in patients with chronic hepatitis B

Cited by 29 publications

References 152 publications

KASL clinical practice guidelines for management of chronic hepatitis B

KASL clinical practice guidelines for management of chronic hepatitis B

Novel Biomarkers of Hepatitis B Virus and Their Use in Chronic Hepatitis B Patient Management

Aiming for Functional Cure With Established and Novel Therapies for Chronic Hepatitis B

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