Switching to entecavir reduces relapse, flare in HBeAg-negative patients

In hepatitis B e antigen-negative (HBeAg) patients, the last antiviral agent used prior to end of therapy (EOT) appears predictive of the timing of clinical relapse, according to a study. An entecavir-switching strategy may prevent relapse and reduce hepatitis flare and its severity within 24 weeks after EOT.

“This strategy seems clinically useful and important for a safer cessation of TDF-based treatment,” the authors said.

Eighteen HBeAg-negative patients treated with tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) switched to entecavir for at least 12 weeks prior to EOT. Participants were matched to two control groups based on age, sex, genotype, baseline hepatitis B virus DNA, quantitative hepatitis B surface antigen, and cirrhosis. They were followed up every 1‒3 months for ≥6 months after EOT.

Switching to entecavir results in lower incidences of clinical relapse (16.7 percent vs 58.3 percent; p=0.009) and hepatitis flare (11.1 percent vs 50 percent; p=0.013) by week 24 compared with the TDF/TAF control.

Similarly, the rate of hepatitis flare with alanine aminotransferase >10 times upper limit of normal was lower with the entecavir group than the TDF/TAF control group (5.6 percent vs 33.3 percent; p=0.040).

“All differences compared with the ETV-control group were nonsignificant,” the authors said.

“Studies have shown that off-therapy clinical relapses occur much more frequently within 24 weeks and seems more severe in TDF-treated than in entecavir-treated patients,” they said.