Predictors of relapse after cessation of nucleos(t)ide analog treatment in HBeAg-negative chronic hepatitis B patients: A meta-analysis

Abstract

Objectives: The aim of this study was to identify the predictors of relapse after the withdrawal of nucleos(t)ide analog (NA) therapy in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB). Methods: The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched through January 2019. A random-effects model meta-analysis was performed, with hazard ratios (HR) and 95% confidence intervals (CI) used as summary statistics. Results: Seventeen studies were included in the meta-analysis. Age (HR = 1.022 per year), baseline hepatitis B surface antigen (HBsAg) (HR = 1.509 per log IU/l), end of treatment (EOT) HBsAg level (HR = 1.896 per log IU/l), EOT HBsAg level ≥1000 IU/ml (HR = 1.749), and HBsAg decline from baseline to EOT (HR = 0.748 per log IU/l) were associated with virological relapse. The predictors of clinical relapse were baseline HBsAg level (HR = 1.312 per log IU/l), EOT HBsAg level (HR = 1.458 per log IU/l), EOT HBsAg level ≥100 IU/ml (HR = 3.199) or ≥1000 IU/ml (HR = 1.810), and duration of consolidation therapy (HR = 0.991 per month). Conclusions: This meta-analysis indicates that age, the duration of consolidation therapy, and levels of baseline and EOT HBsAg were factors predictive of relapse in HBeAg-negative CHB patients who discontinued NA treatment. Keywords: Chronic hepatitis B, HBeAg-negative, Stopping therapy, Nucleot(s)ide analogs