BACKGROUND & AIMS: Q9Predictors of successful nucleo(s)tide analogue (NA) therapy withdrawal remain elusive. We studied the relationship between end-of-treatment levels of hepatitis B core-related antigen (HBcrAg) and hepatitis B surface antigen (HBsAg) and outcome after therapy cessation.
METHODS:Patients who discontinued NA therapy in centers in Asia and Europe were enrolled. HBcrAg and HBsAg were measured at treatment cessation, and associations with off-treatment outcomes were explored. The SCALE Q10 -B score was calculated as previously reported. End points included sustained virologic response (VR; hepatitis B virus DNA level <2000 IU/mL), HBsAg loss, and alanine aminotransferase (ALT) flares (>33 upper limit of normal). Re-treated patients were considered nonresponders.
RESULTS:We analyzed 572 patients, 457 (80%) were Asian and 95 (17%) were hepatitis B e antigen positive at the start of NA therapy. The median treatment duration was 295 weeks. VR was observed in 267 (47%), HBsAg loss was observed in 24 (4.2%), and ALT flare was observed in 92 (16%). VR (67% vs 42% Q11) and HBsAg loss (15% vs 1.5%) was observed more frequently in non-Asian patients (P < .001). Lower HBcrAg levels were associated with higher rates of VR (odds ratio [OR], 0.701; P < .001) and HBsAg loss (OR, 0.476; P < .001), and lower rates of ALT flares (OR, 1.288; P [ .005). Similar results were observed with HBsAg
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Patients of African origin who contract HDV less often have cirrhosis. Patients with HDV and detectable viral load have worse clinical outcomes. Patients with HDV genotype 5 less often develop hepatic decompensation. Patients with HDV genotype 5 seem to respond better to peg-IFN treatment.
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