[205, 206] In fact, evaluation of cases of exacerbated hepatitis following cessation of NA therapy revealed significantly lower levels of HBcrAg (3.2 vs 4.9, P = 0.009) in the non-recurrence group compared
to the recurrence group,[207] indicating that HBcrAg is a potential marker for cessation of NA therapy. Similarly to HBcrAg, HBsAg is thought to be little affected by NA transcriptase inhibition, and the retreatment rate after cessation of NA therapy EGFR inhibitor was significantly lower for the group with low HBsAg levels (<1000 IU/mL) at the time of cessation (18% vs 63%, P = 0.049).[208] Based on the above results, the MHLW research group produced a report titled “Studies concerning efficacy of IFN therapy aimed at creation of treatment discontinuation standards and treatment discontinuation in NAs therapy for hepatitis B”, setting out policy regarding cessation of NA therapy.[209, 210] A summary is shown in Table 14. To determine the criteria for Maraviroc datasheet therapy cessation, as shown below in Table 15, HBsAg and HBcrAg levels at therapy cessation were scored, the final score allocated to the following 3 categories of risk of relapse, and the success rate was predicted. Successful cessation was defined as “finally resulting in inactive carrier status, i.e. ALT ≤30 U/L and HBV DNA <4.0 log copies/mL”. Studies have shown that if this inactive carrier status is achieved,
there is no progression of liver disease, and risk of HCC also declines.[34, 211] Group for which cessation may be considered. However, even in the low risk group, recurrence of hepatitis can occur, so vigilance is required. Group for which cessation may be considered depending on circumstances. This group requires further evaluation concerning cessation criteria and methods. Continued treatment is recommended for this group. However, for patients aged <35, the cessation success rate is relatively high at 30∼40%. Recommendations The following 3 patient criteria must be met for cessation of NA therapy: (1) Both the treating physician
and the patient fully understand that after cessation of NA therapy, there is a high incidence of recurrence of hepatitis, possibly severe; (2) Follow-up is possible after treatment cessation, and appropriate treatment is possible even if hepatitis recurs, MCE (3) Even if recurrence of hepatitis occurs, it is unlikely to be severe if the degree of fibrosis is mild and the hepatic reserve is good. The 3 laboratory criteria for cessation of NA therapy are: (1) At least 2 years of administration of NAs; (2) undetectable serum HBV DNA levels (using real time PCR); (3) negative serum HBeAg at the time of treatment cessation. When the above criteria are met, it is possible to predict the risk of relapse from HBsAg and HBcrAg levels at the time of cessation of therapy. NA therapy should be continued in the high risk group.
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