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Systematic review with meta-analysis: the impact of functional cure on clinical outcomes in patients with chronic hepatitis B.

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Citation: Alimentary Pharmacology & Therapeutics. 55(1):8-25, 2022 01.PMID: 34850415Institution: MedStar Washington Hospital CenterDepartment: Internal Medicine ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Carcinoma, Hepatocellular | *Hepatitis B | *Hepatitis B, Chronic | *Liver Neoplasms | Adult | Carcinoma, Hepatocellular/ep [Epidemiology] | Carcinoma, Hepatocellular/et [Etiology] | Hepatitis B Surface Antigens | Hepatitis B virus | Hepatitis B, Chronic/dt [Drug Therapy] | Humans | Liver Neoplasms/ep [Epidemiology] | MaleYear: 2022 ISSN:

0269-2813

Name of journal: Alimentary pharmacology & therapeuticsAbstract: AIM: To assess the impact of HBsAg loss on clinical outcomes following spontaneous and treatment-related HBsAg loss.BACKGROUND: Although hepatitis B surface antigen (HBsAg) loss is considered the ideal therapeutic endpoint for the treatment of chronic hepatitis B virus (HBV) infection, its impact on clinical outcomes remains uncertain.CONCLUSION: HBsAg loss is associated with a reduced risk of clinical outcomes. However, several shortcomings in the published studies prevent a more definitive conclusion on the potential benefits of HBsAg loss. Copyright (c) 2021 John Wiley & Sons Ltd.METHODS: We searched PUBMED, Embase, the Cochrane library, and published abstracts through to May 2021 for studies that reported HBsAg loss, had >1 year of follow-up and reported at least one clinical outcome in adults with chronic HBV infection.RESULTS: We identified 57 studies (258 744 HBsAg-positive patients, 63 270 with HBsAg loss). Based on 24 studies including 160 598 patients with and without HBsAg loss, HBsAg loss was associated with a non-significant 23% relative risk reduction of developing hepatocellular carcinoma (HCC) compared to those who remained HBsAg-positive (RR = 0.77; 95% CI: 0.38-1.57). In subgroup meta-analysis of 10 studies, treatment-related HBsAg loss was associated with a non-significant higher pooled proportion of HCC (0.94%) compared to spontaneous HBsAg loss (0.45%). HCC development after HBsAg loss was significantly higher in males, those with underlying cirrhosis, and those with a family history of HCC. HBsAg loss was associated with lower pooled proportions of incident cirrhosis, hepatic decompensation, overall and liver-related mortality compared to no HBsAg loss. Substantial heterogeneity was noted across studies for all outcomes.All authors: Auh S, Ghany MG, Hu A, Majeed NA, Sharma D, Terry N, Vittal AOriginally published: Alimentary Pharmacology & Therapeutics. 55(1):8-25, 2022 01.Alimentary Pharmacology & Therapeutics. 55(1):8-25, 2022 Jan.Fiscal year: FY2022 Fiscal year of original publication: FY2022Digital Object Identifier:

https://dx.doi.org/10.1111/apt.16659

Date added to catalog: 2022-01-25

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Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34850415	Available		34850415

AIM: To assess the impact of HBsAg loss on clinical outcomes following spontaneous and treatment-related HBsAg loss.

BACKGROUND: Although hepatitis B surface antigen (HBsAg) loss is considered the ideal therapeutic endpoint for the treatment of chronic hepatitis B virus (HBV) infection, its impact on clinical outcomes remains uncertain.

CONCLUSION: HBsAg loss is associated with a reduced risk of clinical outcomes. However, several shortcomings in the published studies prevent a more definitive conclusion on the potential benefits of HBsAg loss. Copyright (c) 2021 John Wiley & Sons Ltd.

METHODS: We searched PUBMED, Embase, the Cochrane library, and published abstracts through to May 2021 for studies that reported HBsAg loss, had >1 year of follow-up and reported at least one clinical outcome in adults with chronic HBV infection.

RESULTS: We identified 57 studies (258 744 HBsAg-positive patients, 63 270 with HBsAg loss). Based on 24 studies including 160 598 patients with and without HBsAg loss, HBsAg loss was associated with a non-significant 23% relative risk reduction of developing hepatocellular carcinoma (HCC) compared to those who remained HBsAg-positive (RR = 0.77; 95% CI: 0.38-1.57). In subgroup meta-analysis of 10 studies, treatment-related HBsAg loss was associated with a non-significant higher pooled proportion of HCC (0.94%) compared to spontaneous HBsAg loss (0.45%). HCC development after HBsAg loss was significantly higher in males, those with underlying cirrhosis, and those with a family history of HCC. HBsAg loss was associated with lower pooled proportions of incident cirrhosis, hepatic decompensation, overall and liver-related mortality compared to no HBsAg loss. Substantial heterogeneity was noted across studies for all outcomes.

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