Improving the prediction of relapse after nucleos(t)ide analogue discontinuation in patients with chronic hepatitis B.

Background Current guidelines recommend rules for stopping nucleos(t)ide analogues (NAs) in chronic hepatitis B (CHB) patients, but off-therapy relapse is still high. This study aimed to identify predictors of off-therapy relapse and improve existing stopping rules. Methods This retrospective study included 488 CHB patients (262 HBeAg-positive and 226 HBeAg-negative) who discontinued NAs. Post-treatment relapse was investigated. Results During the median follow-up period of 73.3 months, the cumulative 5-year and 10-year virologic relapse (VR) rates were 73.5% and 76.1%, respectively. In HBeAg-positive patients, end-of-therapy hepatitis B surface antigen (HBsAg) levels (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.42-2.61) and consolidation duration ≥2 years (HR, 0.31; 95% CI, 0.17-0.58) were independent predictors of VR. Consolidation ≥2 years and low HBsAg levels (≤560 IU/mL) significantly lowered VR rates. In HBeAg-negative patients, only the HBsAg level (HR, 1.61; 95% CI, 1.24-2.11) was independently predictive of VR. Cirrhosis was significantly associated with higher VR rates in HBeAg-negative patients with low HBsAg levels (≤800 IU/mL). Combining end-of-therapy HBsAg levels with current stopping rules or consolidation duration further reduced off-therapy relapse, with 2-year VR rates of approximately 15%-25% in HBeAg-positive patients and 50% in HBeAg-negative patients. Conclusions End-of-therapy HBsAg levels, consolidation duration, and cirrhosis are key determinants of off-therapy relapse. Together with low HBsAg levels, extended consolidation therapy for ≥2 years should be ensured, and cirrhotic patients should continue NAs even if low HBsAg levels are achieved. A combination of these parameters will help identify individuals at low risk of relapse and significantly improve the predictive ability of the existing stopping rules.