Long-term therapy of hepatits B with NUCs: obstacle to functional cure?

Ending long-term therapy of HBeAg-negative hepatitis B with NUC was believed to induce a functional cure. Data on this was very limited, until a new study.

Discontinuation of NUCs and its influence on disease progression

Nucleos(t)id analogues often mean a lifelong therapy

For people with HBeAg-negative chronic hepatitis B, the disease often means lifelong therapy with NUCs. A functional cure, i.e. the disappearance of HBsAg, is very rarely achieved. For some time now, there have been studies showing that discontinuation of NUC therapy can be accompanied by such a functional cure. But so far the data has been limited to small or non-randomised studies.

Many patients are therefore understandably reluctant to stop treatment with analogues. The fear of an exacerbation of the disease is too great. A recent study was able to provide more data on this topic.

Does stopping NUCs lead to recovery?

The researchers divided 166 patients with chronic hepatitis B and no evidence of HBeAg into two arms: one half discontinued the NUC therapy that had been receiving for years, while the other half continued their treatment unchanged.

After the 96-week follow-up period, the data of 79 people per arm could be analysed. The result: discontinuing NUC led to a functional cure in 10% of the patients. Continuation of the therapy did not result in a drop of HBsAg in any case. This result was statistically highly significant.

Does treatment discontinuation lead to complications?

Although the success of stopping the therapy is impressive, the question arises whether there may have been adverse effects or complications caused by the lack of NUC treatment. The study authors did not report any serious events.

11 of the patients who had stopped their medication in the study setting, had to restart their therapy. However, 32 of the same population achieved remission, although not functional cure.

For whom is NUC discontinuation suitable?

The authors describe that a functional cure of chronic hepatitis B was most likely when HBsAg was below 1,000 IU/ml at the end of NUC therapy.

However, even if no functional cure could be achieved, stopping treatment after several years did not lead to deterioration in most cases. Many of the patients did not have to restart the therapy and some even achieved long-term remission.

There is a strong case for discontinuing the medication

Discontinuation of long-term therapy with nucleos(t)id analogues can lead to a functional cure in some patients with chronic hepatitis B, and much more frequently than if treatment is continued. In general, discontinuation of the medication is well tolerated.