Duration of treatment and stopping therapy
The duration of antiviral therapy for chronic hepatitis B is shown in Duration of antiviral therapy for chronic hepatitis B .
Australian hepatitis B consensus statement 2022
|
Drug |
Duration of antiviral therapy | ||
|---|---|---|---|
|
Immune clearance (HBeAg positive chronic hepatitis) phase |
Immune escape (HBeAg negative chronic hepatitis) phase |
Cirrhosis with any detectable HBV DNA | |
|
entecavir or tenofovir |
for at least 12 months after HBeAg seroconversion, or long term (until HBsAg loss [NB2]) |
long term (until HBsAg loss [NB2]) |
typically lifelong |
|
peginterferon alfa-2a |
48 weeks |
48 weeks |
not recommended |
|
Note:
HBeAg = hepatitis B e antigen; HBsAg = hepatitis B surface antigen; HBV = hepatitis B virus NB1: For more information on duration of antiviral therapy for chronic hepatitis B, see the Australian consensus recommendations for the management of hepatitis B infection, available online. NB2: Treatment can be safely stopped if HBsAg loss occurs and is maintained for more than 3 months. | |||
The decision to stop therapy is complex and should only be made in consultation with a specialist.
The only durable treatment endpoint for chronic hepatitis B is hepatitis B surface antigen (HBsAg) loss, which occurs in less than 1% of treated patients annually.
In patients without cirrhosis, treatment with entecavir or tenofovir can be safely stopped if HBsAg loss occurs and is maintained for more than 3 months. In patients treated with entecavir or tenofovir who have not undergone HBsAg loss, reactivation of hepatitis B and significant hepatitis flares can occur if treatment is stopped.
In patients treated with entecavir or tenofovir in the immune clearance (hepatitis B e antigen [HBeAg] positive chronic hepatitis) phase who do not have cirrhosis, stopping treatment can be considered if HBeAg seroconversion is achieved and has been maintained for at least 12 months. Patients should always be monitored closely for relapse after stopping treatment.
In patients with cirrhosis, lifelong treatment with entecavir or tenofovir is typically recommended because of the high risk of adverse outcomes associated with relapse. In selected patients, cessation of therapy with close monitoring may be considered in consultation with a specialist.
Treatment with peginterferon is recommended for a maximum of 48 weeks based on response to treatment; if antiviral therapy is needed beyond this period, consider entecavir or tenofovir—seek expert advice.