Chronic hepatitis B: a scoping review on the guidelines for stopping nucleos(t)ide analogue therapy

IntroductionNucleos(t)ide analogues (NAs) are effective in suppressing the replication of the hepatitis B virus. However, NAs cannot effectively induce hepatitis B surface antigen (HBsAg) seroclearance, which represents the optimal treatment endpoint in chronic hepatitis B (CHB). Hence, most CHB patients are advised for indefinite NA therapy, but recent data has supported the concept of finite NA therapy before HBsAg seroclearance.Areas coveredThis article covered the latest evidence on stopping NAs in CHB, with a focused analysis on international guidelines. Articles were retrieved by a literature search on PubMed with the keywords 'chronic hepatitis B,' 'antiviral therapy,' 'nucleos(t)ide analogue,' 'cessation,' 'stopping', and 'finite.' Studies up till 1 December 2022 were included.Expert opinionFinite NA therapy in CHB has the potential in enhancing HBsAg seroclearance, however it also carries rare but potentially severe risks. NA cessation before HBsAg seroclearance is only suitable for a highly selected group of patients, whereas the majority of CHB patients should be treated indefinitely or until HBsAg seroclearance. Current guidelines have provided recommendations on stopping NAs, but further research is required to optimize the monitoring and retreatment protocol after stopping NAs.

Automated summary

Nucleos(t)ide analogues (NAs) effectively suppress the replication of hepatitis B virus, but do not effectively induce the clearance of hepatitis B surface antigen (HBsAg), which is the optimal treatment endpoint in chronic hepatitis B (CHB). Recent studies have supported the concept of finite NA therapy before HBsAg seroclearance.