한빛사 논문
Minseok Albert Kim1, Seung Up Kim2,Dong Hyun Sinn3, Jeong Won Jang4, Young-Suk Lim5, Sang Hoon Ahn2, Jae-Jun Shim6, Yeon Seok Seo7, Yang Hyun Baek8, Sang Gyune Kim9, Young Seok Kim9, Ji Hoon Kim10, Won Hyeok Choe11, Hyung Joon Yim12,Hyun Woong Lee13, Jung Hyun Kwon14, Sung Won Lee15, Jae Young Jang16, Hwi Young Kim17, Yewan Park3, Gi-Ae Kim6,Hyun Yang4, Han Ah Lee7, Myeongseok Koh8, Young-Sun Lee10, Minkoo Kim12, Young Chang16, Yoon Jun Kim1, Jung-Hwan Yoon1, Fabien Zoulim18, Jeong-Hoon Lee1,*
1Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
2Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
3Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
4Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
5Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
6Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
7Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
8Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
9Department of Internal Medicine, Bucheon Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
10Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
11Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea
12Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
13Department of Internal Medicine and Yonsei Liver Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
14Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Incheon, South Korea
15Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, Catholic University of Korea, Bucheon, South Korea
16Department of Internal Medicine, Seoul Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
17Department of Inernal Medicine, Ewha Women's University College of Medicine, Seoul, South Korea
18Cancer Research Centre of Lyon, INSERM U1052, Lyon University, Hospices Civils de Lyon, Lyon, France
MAK, SUK and DHS are joint first authors.
*Corresponding author
Abstract
Objective
Direct comparison of the clinical outcomes between nucleos(t)ide analogue (NA) discontinuation versus NA continuation has not been performed in patients with chronic hepatitis B who achieved HBsAg-seroclearance. Whether NA discontinuation was as safe as NA continuation after NA-induced surface antigen of HBV (HBsAg) seroclearance was investigated in the present study.
Designs
This multicentre study included 276 patients from 16 hospitals in Korea who achieved NA-induced HBsAg seroclearance: 131 (47.5%) discontinued NA treatment within 6 months after HBsAg seroclearance (NA discontinuation group) and 145 (52.5%) continued NA treatment (NA continuation group). Primary endpoint was HBsAg reversion and secondary endpoints included serum HBV DNA redetection and development of hepatocellular carcinoma (HCC).
Results
During follow-up (median=26.9 months, IQR=12.2–49.2 months), 10 patients (3.6%) experienced HBsAg reversion, 6 (2.2%) showed HBV DNA redetection and 8 (2.9%) developed HCC. Compared with NA continuation, NA discontinuation was not associated with HBsAg reversion in both univariable (HR=0.45, 95% CI=0.12 to 1.76, log-rank p=0.24) and multivariable analyses (adjusted HR=0.65, 95% CI=0.16 to 2.59, p=0.54). The cumulative probabilities of HBsAg reversion at 1, 3 and 5 years were 0.8%, 2.3% and 5.0% in the NA discontinuation group, and 1.5%, 6.3% and 8.4% in the NA continuation group, respectively. NA discontinuation was not associated with higher risk of either HBV redetection (HR=0.83, 95% CI=0.16 to 4.16, log-rank p=0.82) or HCC development (HR=0.53, 95% CI=0.12 to 2.23, log-rank p=0.38).
Conclusion
The discontinuation of NA was not associated with a higher risk of either HBsAg reversion, serum HBV DNA redetection or HCC development compared with NA continuation among patients who achieved HBsAg seroclearance with NA.
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TOP52020년 후보
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