{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:04:53Z","timestamp":1785168293925,"version":"3.55.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T00:00:00Z","timestamp":1628208000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>Nucleoside analogue (NA) therapy for chronic hepatitis B (CHB) is associated with improved clinical outcomes, but usually requires long\u2010term use. Whether treatment can be safely withdrawn and the factors associated with post\u2010withdrawal outcome are not well defined. To assess long\u2010term outcomes after stopping antiviral therapy, patients with hepatitis B e antigen (HBeAg)\u2013negative CHB who had received antiviral therapy for 4 or more years with hepatitis B virus (HBV) DNA (\u2264100\u00a0IU\/mL) were prospectively withdrawn from antiviral therapy and monitored monthly for the initial 6\u00a0months and every 3\u00a0months thereafter. Those with clinical relapse were retreated according to severity of relapse. Fifteen patients were withdrawn from lamivudine (4), adefovir (5), or a combination of the two (6) after a mean treatment duration of 8.4\u00a0years. The mean age was 45\u00a0years, 13 were male, and 8 were initially HBeAg\u2010positive before treatment. After a mean follow\u2010up of 6.6\u00a0years, outcomes differed by pretreatment HBeAg status. All patients who were HBeAg+ before treatment experienced virological relapse (8 of 8); 6 of 8 experienced clinical relapse; 4 of 8 had ALT flares; 5 of 8 required re\u2010initiation of treatment, one of whom cleared hepatitis B surface antigen (HBsAg); and 3 of 8 remained off treatment, one of whom cleared HBsAg. In contrast, 4 of 7 patients who were HBeAg\u2010negative before treatment experienced virological relapse, 3 of 7 experienced clinical relapse, and 1 of 7 had an alanine aminotransferase (ALT) flare. None restarted treatment, and 4 of 7 cleared HBsAg. Low pre\u2010withdrawal HBsAg level was predictive of HBsAg loss. <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: NA therapy can be safely withdrawn with long\u2010term remission and high rates of HBsAg loss in most HBeAg\u2010negative patients without cirrhosis. Patients who were initially HBeAg+ should not be withdrawn from treatment, because clinical relapse was frequent and often severe.<\/jats:p>","DOI":"10.1002\/hep4.1761","type":"journal-article","created":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T07:43:43Z","timestamp":1628322223000},"page":"1888-1900","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Prospective Study of Withdrawal of Antiviral Therapy in Patients with Chronic Hepatitis B after Prolonged Virological Response"],"prefix":"10.1097","volume":"5","author":[{"given":"Naveen","family":"Gara","sequence":"first","affiliation":[{"name":"Gastroenterology & Liver Institute,Escondido,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele M.","family":"Tana","sequence":"additional","affiliation":[{"name":"University of California San Francisco School of Medicine,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meera","family":"Kattapuram","sequence":"additional","affiliation":[{"name":"Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungyoung","family":"Auh","sequence":"additional","affiliation":[{"name":"Clinical Core,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Fryzek","sequence":"additional","affiliation":[{"name":"Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Walter","sequence":"additional","affiliation":[{"name":"Clinical Core,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Umarova","sequence":"additional","affiliation":[{"name":"Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiongce","family":"Zhao","sequence":"additional","affiliation":[{"name":"Office of the Director,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Cloherty","sequence":"additional","affiliation":[{"name":"Abbott Diagnostics,Abbott Park,IL,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Doo","sequence":"additional","affiliation":[{"name":"Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Heller","sequence":"additional","affiliation":[{"name":"Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. 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