Anti-HBc level predicting virological relapse after stopping nucleos(t)ide analogue in chronic hepatitis B
Journal
Liver international : official journal of the International Association for the Study of the Liver
Journal Volume
43
Journal Issue
4
Pages
947
Date Issued
2023-04
Author(s)
Abstract
We read with great interest the paper by Ohlendorf et al.,1 in which they found that lower anti-HBc levels were associated with a significantly lower relapse risk after nucleos(t)ide analogue (NA) cessation in HBeAg-negative patients. In contrast, two previous studies demonstrated a trend that lower anti-HBc levels were associated with a higher risk of clinical relapse.2, 3 In our earlier study,4 a total of 100 patients who discontinued entecavir (ETV) or tenofovir (TDF) therapy after a median of 3-year usage with a follow-up of 24 months were included for the analysis of clinical outcomes. Of 72 HBeAg-negative patients, the serum anti-HBc level at end-of-therapy (EOT) could not predict virological relapse (hazard ratio [HR]: 1.24, 95% confidence interval [CI]: 0.72–2.12, p = .438), and clinical relapse (HR: 0.92 (95% CI: 0.49–1.74), p = .801). (Table 1). The discrepant results amongst these studies may be reasoned by the heterogeneity of HBeAg-positive and HBeAg-negative patients before NA initiation,1-4 and different immunoassays for the quantification of anti-HBc level, including Wantai, Beijing, China (dynamic range, 0.08–2.5 IU/mL) and Fujirebio Europe (Fujirebio Japan, dynamic range 0.005 IU/mL to 1.500 IU/mL). In addition, the follow-up duration was only 24 weeks after NA cessation in the current study, which might be too short to identify late relapsers. Although Ohlendorf et al. demonstrated that ABX 203 vaccine would not alter the risk of off-therapy relapse, it remained unclear whether the trial vaccine would affect the anti-HBc level. In summary, Ohlendorf et al. are congratulated to provide positive evidence of total anti-HBc for the prediction of relapse off NA therapy. However, this novel serological marker should be further validated in more clinical scenarios of different populations.
SDGs
Publisher
WILEY
Type
letter