Kaewdech A, Sripongpun P. Challenges in the discontinuation of chronic hepatitis B antiviral agents. World J Hepatol 2021; 13(9): 1042-1057 [PMID: 34630873 DOI: 10.4254/wjh.v13.i9.1042]
Corresponding Author of This Article
Pimsiri Sripongpun, MD, Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai 90110, Songkhla, Thailand. spimsiri@medicine.psu.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Sep 27, 2021; 13(9): 1042-1057 Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1042
Challenges in the discontinuation of chronic hepatitis B antiviral agents
Apichat Kaewdech, Pimsiri Sripongpun
Apichat Kaewdech, Pimsiri Sripongpun, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
Author contributions: Kaewdech A and Sripongpun P made a substantial contribution to the review concept and drafting of the manuscript; Sripongpun P made a critical revision of the manuscript; All authors approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pimsiri Sripongpun, MD, Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai 90110, Songkhla, Thailand. spimsiri@medicine.psu.ac.th
Received: February 21, 2021 Peer-review started: February 21, 2021 First decision: May 3, 2021 Revised: May 7, 2021 Accepted: July 28, 2021 Article in press: July 28, 2021 Published online: September 27, 2021
Abstract
Long-term antiviral treatment of chronic hepatitis B patients has been proven to be beneficial in reducing liver-related complications. However, lengthy periods of daily administration of medication have some inevitable drawbacks, including decreased medication adherence, increased cost of treatment, and possible long-term side effects. Currently, discontinuation of antiviral agent has become the strategy of interest to many hepatologists, as it might alleviate the aforementioned drawbacks and increase the probability of achieving functional cure. This review focuses on the current evidence of the outcomes following stopping antiviral treatment and the factors associated with subsequent hepatitis B virus relapse, hepatitis B surface antigen clearance, and unmet needs.
Core Tip: Stop strategy is one of the options to get closer to functional cure with a finite duration of treatment in chronic hepatitis B patients. Virological relapse and clinical relapse are common after stopping antiviral agent. Half the patients with clinical relapse require retreatment. Novel biomarkers and the SCALE-B score predict clinical relapse and hepatitis B surface antigen clearance. Knowing when to restart treatment and novel sensitive biomarkers are unmet needs.
