Overview
Relapsing viral hepatitis, specifically in the context of hepatitis B virus (HBV) infection, can occur after cessation of nucleos(t)ide analogue (NUC) therapy 1. This relapse is characterized by a significant increase in viral load 1.Diagnosis
Management
Pegylated interferon alpha-2a (PegIFN-α-2a) administered for 48 weeks can reduce virological relapse rates in HBeAg-negative chronic hepatitis B patients after NUC cessation 1.
In a randomized controlled trial, switching from NUC to 48 weeks of PegIFN-α-2a resulted in significantly lower cumulative virological relapse rates up to week 96 compared to NUC cessation alone (20.8% vs. 53.6%, p <0.0001) 1.
At 48 weeks off treatment, the interferon monotherapy group also showed a significantly lower proportion of virological relapse compared to the NUC cessation group (17.8% vs. 36.7%, p = 0.007) 1.
Clinical relapse rates were also lower in the interferon monotherapy group (7.8% vs. 20.9%, p = 0.008) 1.
Virological relapse after NUC cessation positively correlated with baseline HBsAg levels 1.Special Populations
Key Recommendations
Consider pegylated interferon alpha-2a (PegIFN-α-2a) for 48 weeks in HBeAg-negative patients with chronic hepatitis B who are on long-term nucleos(t)ide analogue (NUC) therapy to reduce virological relapse after NUC cessation 1. (Evidence: Strong)
Patients discontinuing NUC therapy should be monitored for virological relapse, as rates can be high (up to 53.6% by week 96 in one study) 1. (Evidence: Strong)
Higher baseline HBsAg levels may predict a greater risk of virological relapse after NUC cessation 1. (Evidence: Moderate)References
1 Li F, Qu L, Liu Y, Wu X, Qi X, Wang J et al.. PegIFN alpha-2a reduces relapse in HBeAg-negative patients after nucleo(s)tide analogue cessation: A randomized-controlled trial. Journal of hepatology 2025. link