{"doi":"10.1002/hep4.1761","title":"Prospective Study of Withdrawal of Antiviral Therapy in Patients with Chronic Hepatitis B after Prolonged Virological Response","abstract":"Nucleoside analogue (NA) therapy for chronic hepatitis B (CHB) is associated with improved clinical outcomes, but usually requires long-term use. Whether treatment can be safely withdrawn and the factors associated with post-withdrawal outcome are not well defined. To assess long-term outcomes after stopping antiviral therapy, patients with hepatitis B e antigen (HBeAg)-negative CHB who had received antiviral therapy for 4 or more years with hepatitis B virus (HBV) DNA (≤100 IU/mL) were prospectively withdrawn from antiviral therapy and monitored monthly for the initial 6 months and every 3 months thereafter. Those with clinical relapse were retreated according to severity of relapse. Fifteen patients were withdrawn from lamivudine (4), adefovir (5), or a combination of the two (6) after a mean treatment duration of 8.4 years. The mean age was 45 years, 13 were male, and 8 were initially HBeAg-positive before treatment. After a mean follow-up of 6.6 years, outcomes differed by pretreatment HBeAg status. All patients who were HBeAg+ before treatment experienced virological relapse (8 of 8); 6 of 8 experienced clinical relapse; 4 of 8 had ALT flares; 5 of 8 required re-initiation of treatment, one of whom cleared hepatitis B surface antigen (HBsAg); and 3 of 8 remained off treatment, one of whom cleared HBsAg. In contrast, 4 of 7 patients who were HBeAg-negative before treatment experienced virological relapse, 3 of 7 experienced clinical relapse, and 1 of 7 had an alanine aminotransferase (ALT) flare. None restarted treatment, and 4 of 7 cleared HBsAg. Low pre-withdrawal HBsAg level was predictive of HBsAg loss. Conclusion: NA therapy can be safely withdrawn with long-term remission and high rates of HBsAg loss in most HBeAg-negative patients without cirrhosis. Patients who were initially HBeAg+ should not be withdrawn from treatment, because clinical relapse was frequent and often severe.","journal":"Hepatology Communications","year":2021,"id":198540,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9531,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":672208,"name":"Michele Tana","orcid":"0000-0002-3665-2735","position":1,"is_corresponding":false},{"id":774370,"name":"Meera Kattapuram","orcid":null,"position":2,"is_corresponding":false},{"id":355656,"name":"Sungyoung Auh","orcid":"0000-0002-3901-0869","position":3,"is_corresponding":false},{"id":774371,"name":"Lauren A. Sullivan","orcid":null,"position":4,"is_corresponding":false},{"id":774372,"name":"Nancy Fryzek","orcid":null,"position":5,"is_corresponding":false},{"id":234133,"name":"Mary Walter","orcid":null,"position":6,"is_corresponding":false},{"id":319204,"name":"Regina Umarova","orcid":null,"position":7,"is_corresponding":false},{"id":774373,"name":"Xiongce Zhao","orcid":null,"position":8,"is_corresponding":false},{"id":248628,"name":"Gavin Cloherty","orcid":null,"position":9,"is_corresponding":false},{"id":286081,"name":"Edward Doo","orcid":"0000-0002-5245-3429","position":10,"is_corresponding":false},{"id":334105,"name":"Theo Heller","orcid":"0000-0002-2643-6289","position":11,"is_corresponding":false},{"id":242482,"name":"T. Jake Liang","orcid":"0000-0003-3828-702X","position":12,"is_corresponding":false},{"id":270560,"name":"Marc G. Ghany","orcid":"0000-0003-2837-0188","position":13,"is_corresponding":false},{"id":273247,"name":"Naveen Gara","orcid":null,"position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":null,"created_at":"2026-07-18T23:50:31.857233Z","pmid":"34558806","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}