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Study on Post-Treatment Relapse in HBeAg Positive CHB Patients.

Lu J, Li J, Liu Y, Ren S, Cao Z, Jin Y, Ma L, Shen C, Chen X - PLoS ONE (2015)

Bottom Line: The predictive effects of the influence factors were evaluated in an eP-CHB prospective cohort. 89 patients were enrolled in the retrospective study, 42(47.2%) relapsed after discontinuation of treatment.The antiviral therapy in eP-CHB patients should be individually managed at different levels.It is better to treat those with higher viral load and lower HBeAg levels at baseline for a longer course, especially longer consolidation duration so as to decrease the relapse rate.

View Article: PubMed Central - PubMed

Affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.

ABSTRACT

Background: Many factors are associated with post-treatment relapse in CHB patients, and there are no effective factors to predict relapse. In this study, we investigate the influence factors associated with post-treatment relapse and their predictive value in HBeAg positive CHB (eP-CHB).

Methods: The factors associated with post-treatment relapse were analyzed firstly by a retrospective study in eP-CHB. Variables included age, sex, regimen, baseline HBeAg and HBV DNA level, total course of treatment as well as duration of consolidation therapy after HBeAg seroconversion. The predictive effects of the influence factors were evaluated in an eP-CHB prospective cohort.

Results: 89 patients were enrolled in the retrospective study, 42(47.2%) relapsed after discontinuation of treatment. Factors related to post-treatment relapse were total course of treatment, duration of consolidation therapy and baseline HBV DNA level. Relapse rates in patients with total course >36 months, consolidation duration >12 months and baseline HBV DNA level < 1.0E+5IU/ml were lower than those of total course <24 months (P = 0.002), consolidation duration≤12 months (P = 0.011) and baseline HBV DNA level > 1.0E+7IU/ml (P = 0.01) respectively. Patients with HBV DNA≥1.0E+7IU/ml plus HBeAg<200COI at baseline had the highest relapse rate and cumulative relapse rate than the other three arms (P = 0.048 and 0.008 respectively). Logistic regression analysis demonstrated that baseline HBV DNA level, duration of consolidation therapy and combination of baseline HBV DNA and HBeAg (IgDNA/IgHBeAg) were independent factors to predict post-treatment relapse. The model based on baseline IgDNA/IgHBeAg and consolidation duration worked well in predicting post-treatment relapse in the prospective study and the accuracy, specificity, sensitivity, PPV and NPV for prediction were 80.3%, 81.1%, 79.2%, 73.1% and 85.7% respectively.

Conclusions: Virological factors including baseline HBV DNA, HBeAg and treatment course were major influence factors associated with post-treatment relapse in eP-CHB. Patients with higher HBV DNA and lower HBeAg levels at baseline, shorter total course as well as consolidation therapy were more likely to develop relapse after discontinuation of therapy. The antiviral therapy in eP-CHB patients should be individually managed at different levels. It is better to treat those with higher viral load and lower HBeAg levels at baseline for a longer course, especially longer consolidation duration so as to decrease the relapse rate.

No MeSH data available.


Related in: MedlinePlus

ROC curves of the independent factors based on retrospective study for predicting relapse.ROC curve of the IgDNA in differentiating post-treatment relapse with AUC 0.678 (A), ROC curve of IgDNA/IgHBeAg with AUC 0.754 (B) and IgDNA/IgHBeAg combined with consolidation duration with AUC 0.824 (C).
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pone.0141072.g002: ROC curves of the independent factors based on retrospective study for predicting relapse.ROC curve of the IgDNA in differentiating post-treatment relapse with AUC 0.678 (A), ROC curve of IgDNA/IgHBeAg with AUC 0.754 (B) and IgDNA/IgHBeAg combined with consolidation duration with AUC 0.824 (C).

Mentions: Based on retrospective data, Baseline IgDNA, baseline IgDNA/IgHBeAg and duration of consolidation therapy were three independent factors influencing post-treatment relapse. Subsequently, ROC curves of the IgDNA, IgDNA/IgHBeAg and IgDNA/IgHBeAg combined with consolidation duration in differentiating relapse were drawn. Area under the curves (AUC) was 0.678, 0.754 and 0.824 respectively (Fig 2A, 2B and 2C). The IgDNA/IgHBeAg combined with consolidation duration had the biggest AUC, which had the most significant value in predicting relapse. Date from the prospective study was introduced in the ROC generated by IgDNA/IgHBeAg combined with consolidation duration. The optimized cut-off value of 0.590 produced a sensitivity of 79.2%, specificity of 81.1%, positive predictive value (PPV) of 73.1%, negative predictive value (NPV) of 85.7%, possibility of correct classification of 80.3% (Table 4). The results support that baseline IgDNA/IgHBeAg combined with consolidation duration are good prediction markers for post-treatment relapse.


Study on Post-Treatment Relapse in HBeAg Positive CHB Patients.

Lu J, Li J, Liu Y, Ren S, Cao Z, Jin Y, Ma L, Shen C, Chen X - PLoS ONE (2015)

ROC curves of the independent factors based on retrospective study for predicting relapse.ROC curve of the IgDNA in differentiating post-treatment relapse with AUC 0.678 (A), ROC curve of IgDNA/IgHBeAg with AUC 0.754 (B) and IgDNA/IgHBeAg combined with consolidation duration with AUC 0.824 (C).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4629894&req=5

pone.0141072.g002: ROC curves of the independent factors based on retrospective study for predicting relapse.ROC curve of the IgDNA in differentiating post-treatment relapse with AUC 0.678 (A), ROC curve of IgDNA/IgHBeAg with AUC 0.754 (B) and IgDNA/IgHBeAg combined with consolidation duration with AUC 0.824 (C).
Mentions: Based on retrospective data, Baseline IgDNA, baseline IgDNA/IgHBeAg and duration of consolidation therapy were three independent factors influencing post-treatment relapse. Subsequently, ROC curves of the IgDNA, IgDNA/IgHBeAg and IgDNA/IgHBeAg combined with consolidation duration in differentiating relapse were drawn. Area under the curves (AUC) was 0.678, 0.754 and 0.824 respectively (Fig 2A, 2B and 2C). The IgDNA/IgHBeAg combined with consolidation duration had the biggest AUC, which had the most significant value in predicting relapse. Date from the prospective study was introduced in the ROC generated by IgDNA/IgHBeAg combined with consolidation duration. The optimized cut-off value of 0.590 produced a sensitivity of 79.2%, specificity of 81.1%, positive predictive value (PPV) of 73.1%, negative predictive value (NPV) of 85.7%, possibility of correct classification of 80.3% (Table 4). The results support that baseline IgDNA/IgHBeAg combined with consolidation duration are good prediction markers for post-treatment relapse.

Bottom Line: The predictive effects of the influence factors were evaluated in an eP-CHB prospective cohort. 89 patients were enrolled in the retrospective study, 42(47.2%) relapsed after discontinuation of treatment.The antiviral therapy in eP-CHB patients should be individually managed at different levels.It is better to treat those with higher viral load and lower HBeAg levels at baseline for a longer course, especially longer consolidation duration so as to decrease the relapse rate.

View Article: PubMed Central - PubMed

Affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.

ABSTRACT

Background: Many factors are associated with post-treatment relapse in CHB patients, and there are no effective factors to predict relapse. In this study, we investigate the influence factors associated with post-treatment relapse and their predictive value in HBeAg positive CHB (eP-CHB).

Methods: The factors associated with post-treatment relapse were analyzed firstly by a retrospective study in eP-CHB. Variables included age, sex, regimen, baseline HBeAg and HBV DNA level, total course of treatment as well as duration of consolidation therapy after HBeAg seroconversion. The predictive effects of the influence factors were evaluated in an eP-CHB prospective cohort.

Results: 89 patients were enrolled in the retrospective study, 42(47.2%) relapsed after discontinuation of treatment. Factors related to post-treatment relapse were total course of treatment, duration of consolidation therapy and baseline HBV DNA level. Relapse rates in patients with total course >36 months, consolidation duration >12 months and baseline HBV DNA level < 1.0E+5IU/ml were lower than those of total course <24 months (P = 0.002), consolidation duration≤12 months (P = 0.011) and baseline HBV DNA level > 1.0E+7IU/ml (P = 0.01) respectively. Patients with HBV DNA≥1.0E+7IU/ml plus HBeAg<200COI at baseline had the highest relapse rate and cumulative relapse rate than the other three arms (P = 0.048 and 0.008 respectively). Logistic regression analysis demonstrated that baseline HBV DNA level, duration of consolidation therapy and combination of baseline HBV DNA and HBeAg (IgDNA/IgHBeAg) were independent factors to predict post-treatment relapse. The model based on baseline IgDNA/IgHBeAg and consolidation duration worked well in predicting post-treatment relapse in the prospective study and the accuracy, specificity, sensitivity, PPV and NPV for prediction were 80.3%, 81.1%, 79.2%, 73.1% and 85.7% respectively.

Conclusions: Virological factors including baseline HBV DNA, HBeAg and treatment course were major influence factors associated with post-treatment relapse in eP-CHB. Patients with higher HBV DNA and lower HBeAg levels at baseline, shorter total course as well as consolidation therapy were more likely to develop relapse after discontinuation of therapy. The antiviral therapy in eP-CHB patients should be individually managed at different levels. It is better to treat those with higher viral load and lower HBeAg levels at baseline for a longer course, especially longer consolidation duration so as to decrease the relapse rate.

No MeSH data available.


Related in: MedlinePlus