Extended lamivudine consolidation therapy in hepatitis B e antigen-positive chronic hepatitis B patients improves sustained hepatitis B e antigen seroconversion

Objectives. Longer lamivudine (LAM) consolidation therapy after hepatitis B e antigen (HBeAg) seroconversion has been demonstrated to reduce the cumulative relapse rate. However, the optimal interval of LAM consolidation therapy remains controversial. We evaluated the post-treatment durability of LAM-induced HBeAg seroconversion and the length of LAM consolidation therapy required to maintain sustained HBeAg seroconversion. Material and methods. This retrospective study included 401 naive HBeAg-positive chronic hepatitis B patients who were treated with LAM 100 mg daily for at least 24 weeks (range 24-258 weeks). Among them, 124 patients who achieved a complete response (HBeAg seroconversion, alanine aminotransferase normalization, hepatitis B virus DNA <200 copies/ml) at the end of LAM therapy were followed up for at least 48 weeks (range 48-350 weeks). Results. Of the 124 complete responders, 42 (33.87%) achieved a sustained response (persistent response ≥ 48 weeks). However, the cumulative relapse rates at 48 and 96 weeks post-treatment were 54.03% and 68.4%, respectively. Multivariate analysis revealed pretreatment age ≤ 34 years [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.40-3.62; p <0.001] and LAM consolidation therapy ≥ 48 weeks (HR 2.44; 95% CI 1.35-4.40; p 0.003) to be independent factors for predicting a sustained response. Conclusions. LAM-induced HBeAg seroconversion is not durable in Taiwan. However, a duration of LAM consolidation therapy >48 weeks may be favorable for maintaining durable HBeAg seroconversion.