Abstract
Introduction: Loss of hepatitis B surface antigen (HBsAg) is the pivotal component of functional cure in patients suffering from chronic hepatitis B (CHB). The predictive value of quantitative HBsAg (qHBsAg) in HBsAg loss among those undergoing nucleos(t)ide analogue (NAs) therapy is an area of ongoing investigation. Methods: A retrospective cohort study using electronic medical records was performed. CHB patients with NAs treatment between 01-January-2012 and 31-December-2020 were enrolled and followed-up until discontinuation of NAs, as indicated by a gap more than 12 months in prescription refills, last medical record, or study end. Patients were grouped into NAs treatment-naïve cohort and treatment-experienced cohort. In both cohorts, Cox regression models assessed associations between 12-month reduction in qHBsAg, baseline qHBsAg and HBsAg loss. Results: In overall, 2,627 CHB patients with NAs treatment was identified, including 1,179 in treatment-naïve cohort and 1,448 in treatment-experienced cohort. In treatment-naïve cohort, 9 patients had HBsAg loss (0.51/100 person-years). In treatment-experienced cohort, 30 patients had HBsAg loss (1.03/100 person-years). HBsAg loss was significantly associated with a 0.5–1 log10 (treatment-naïve: aHR 8.06, 95%CI 1.29-50.40; treatment-experienced: aHR 4.34, 95%CI 1.40-13.47) and >1 log10 qHBsAg decrease (treatment-naïve: aHR 9.19, 95%CI 1.47-57.65; treatment-experienced: aHR 8.02, 95%CI 1.76-36.57) compared with qHBsAg not reduced. HBsAg loss was significantly associated with lower baseline qHBsAg in treatment-experienced cohort, while such difference was not significant in treatment-naïve cohort. Discussion: A rapid decline of qHBsAg in 12 months during NAs therapy, as opposed to merely maintaining a low level of qHBsAg, was associated with HBsAg loss.
Published Version
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