Challenges in the discontinuation of chronic hepatitis B antiviral agents

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.

Keywords: Viral hepatitis B; Relapse; Retreatment; SCALE-B; Stop treatment strategy; Nucleoside analogs

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.