Durability of hepatitis B surface antigen seroclearance and subsequent risk for hepatocellular carcinoma: A meta‐analysis

Abstract

Hepatitis B surface antigen (HBsAg) seroclearance is regarded as the ideal endpoint for antiviral treatment. However, reports on the durability of and outcomes after HBsAg seroclearance are few, which has become a focus in clinical practice. This meta‐analysis was performed to evaluate the durability and hepatocellular carcinoma (HCC) incidence after HBsAg seroclearance after treatment cessation. We searched PubMed, Embase, Medline and Web of Science for studies that reported the durability and HCC incidence after HBsAg seroclearance published between 1 January 2000 and 31 January 2020. Data were analysed by a random‐effects model. Thirty‐eight studies and 43,924 patients were finally included. The results showed that HBsAg seroclearance was durable, with a pooled recurrence rate of 6.19% (95% CI: 4.10%–8.68%). There was no significant difference in recurrence rates after different seroclearance methods or among recurrence types and different regions. Anti‐HBs seroconversion resulted in a significantly reduced recurrence rate (RR = 0.25, p < .001). Patients who experienced HBsAg seroclearance had significantly lower HCC incidence than HBsAg‐positive (RR = 0.41, p < .001). The pooled HCC incidence after HBsAg seroclearance was 1.88%; this rate was reduced to 0.76% among patients without baseline cirrhosis. In conclusion, the analysis during an average follow‐up of 4.74 years suggested that in patients who experienced sustained HBsAg seroclearance and anti‐HBs seroconversion, this was associated with low HCC incidence. Patients without baseline cirrhosis benefited even more. We emphasize the importance of gaining HBsAg seroclearance while highlighting the benefits of achieving this as early as possible.

Study on the Retreatment, Outcome, and Potential Predictors of Recurrence in Patients With Recurrence of Hepatitis B After Functional Cure

“…HBsAg seroclearance or seroconversion has been considered the ideal treatment endpoint for CHB patients ( 1 – 3 ). Some studies showed that the long-term prognosis of patients with CHB could be improved after functional cure ( 4 , 8 , 9 , 12 ). However, relapse still occurs in some patients, and the types of relapse are diverse.…”

“…Recently, studies related to hepatitis B surface antigen (HBsAg) clearance have increased, but there are still fewer studies related to recurrence after HBsAg clearance. Our previous study and a meta-analysis found that the recurrence rate after functional cure was 6.19%–9.66%, including cases with HBsAg positivity and/or hepatitis B virus (HBV) DNA positivity ( 4 , 5 ). Due to the few large or even sufficient sample relapse cohorts are available for analysis, the effectiveness of retreatment and clinical outcomes after relapse and the correlation between immune function and relapse are even rarer.…”

Cost-effectiveness of combination antiviral treatment with extended duration for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B in China

“…A recent meta-analysis review paper involving 43,924 patients with chronic hepatitis B found a total recurrence rate after HBsAg clearance of 6.19%, with an average follow-up of 4.74 years. The overall stability was good (38), but there were significant differences between different research populations. We therefore did not include this data.…”

An Ideal Hallmark Closest to Complete Cure of Chronic Hepatitis B Patients: High-sensitivity Quantitative HBsAg Loss

“…73,74 A recent meta-analysis reported that CHB patients had a durable negative HBsAg response after HBsAg seroclearance. 75…”