The times they are a-changing – A refined proposal for finite HBV nucleos(t)ide analogue therapy

Abstract

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Current Trend in Antiviral Therapy for Chronic Hepatitis B

“…Clearly, a paradigm shift from indefinite long-term/life-long NUC therapy to finite therapy in HBeAg-negative patients is emerging [39]. European experts even consider that the strategy of finite therapy is not only an option but also becoming a more specific recommendation in future guidelines [56]. N: normal; ULN: upper limit of normal; data adapted from reference [48].…”

New concepts regarding finite oral antiviral therapy for HBeAg-negative chronic hepatitis B

“…We read with great interest the recent Expert Opinion by Thomas Berg and Pietro Lampertico on a refined proposal for finite nucleos(t)ide analogue (NA) therapy in HBeAg-negative chronic hepatitis B (CHB). 1 This is a timely article by two experts in hepatitis B proposing a carefully balanced approach for improved implementation of individualized management of HBeAg-negative CHB patients with proper use of finite NA therapy, leading to increased functional cure rates in this setting. [1][2][3] In an effort to further clarify a few issues, we would like to share our thoughts based on data from our prospective DARING-B study and our experience from daily clinical practice.…”

“…A key concept in this Expert Opinion is "the stop to relapse hypothesis", which is considered as the main step for the induction of functional cure. 1 There is no doubt that the hypothesis is quite attractive and that a variable proportion of HBeAg-negative CHB patients who discontinue NAs and achieve HBsAg loss have a post-NA course that fulfills this hypothesis. [4][5][6] However, another variable proportion of such patients may achieve HBsAg loss not only without any ALT elevation but also without any HBV DNA rebound, at least by assays with standard sensitivities.…”

“…As mentioned in the Expert Opinion, the need for closer post-NA monitoring is considered to be one of the limitations of the finite NA therapy in HBeAgnegative CHB. 1 This is a correct argument, in comparison to continuing effective long-term NA therapy, but it is true only for the first year after NA discontinuation. 2 Most of virological and biochemical relapses requiring retreatment, or not, develop within the first 12 months after NA cessation, [6][7][8][9] while follow-up every 6 months is usually recommended for patients remaining without retreatment after month 12 and even less frequently in those with confirmed HBsAg loss.…”

I shall be released (from infinite HBV nucleos(t)ide analog therapy): Japanese experience

“…To the editor: We read with great interest the article by Berg et al [1] titled "The times they are a-changing." The authors proposed that hepatitis B virus (HBV) relapse after nucleos(t)ide analog (NA) discontinuation could achieve hepatitis B surface antigen (HBsAg) seroclearance according to the "stop-to-cure" approach.…”