Is it good for hepatitis B patients to receive nucleoside therapy?

There are two main classes of antiviral drugs for chronic hepatitis B: interferons and nucleoside analogues. Interferons provide a durable response after a limited course of therapy with a relatively high chance of discontinuation, while nucleoside analogs inhibit viral replication rapidly, with faster HBV DNA conversion seen in clinical practice. Although interferons were introduced earlier, nucleoside analogs have since taken over, and more and more patients are choosing nucleoside analogs for treatment due to more aspects of oral administration, among other reasons. However, after long-term application, one of the main limitations of these drugs has become more and more apparent: the tendency to relapse when the drug is discontinued and the need for long-term treatment. In order to pursue better efficacy and quality of life, many patients receiving nucleoside analogs wish to stop taking them. The answer is yes. With scientific treatment, nucleoside treated patients also have the opportunity to discontinue their medication. There are 2 options for nucleoside treated patients to discontinue their medication: Method 1: Adhere to nucleoside analog therapy and discontinue it after achieving e antigen conversion through consolidation therapy. The authoritative domestic and international guidelines for chronic hepatitis B have clear recommendations for discontinuation of nucleoside therapy, i.e., a period of consolidation therapy is required after e antigen conversion before attempting to discontinue the drug. However, it should be noted that nucleoside therapy has a limited e antigen conversion rate, and the study results show that the 1-year e antigen conversion rate of all types of nucleoside therapy does not exceed 20%, and the long-term treatment e antigen conversion rate does not exceed 30%. In addition, even with e antigen conversion and consolidation therapy, most patients are at risk of relapse after discontinuation. Therefore, pursuing discontinuation with this regimen requires a great deal of patience and anticipation of treatment outcomes. Approach 2: Switching treatment regimens and receiving long-acting interferon therapy. For primary treatment patients, long-acting interferon is the first-line treatment option to achieve a durable response after discontinuation, and study results have shown equally good outcomes with long-acting interferon for nucleoside transcutaneous patients. For example, the results of the OSST study found that nucleoside treated patients with HBV DNA conversion and HBeAg clearance and low quantitative levels of HBsAg had a more than 3-fold increase in e antigen conversion and 25% clearance of surface antigen after 1 year of treatment with long-acting interferon alpha-2a compared to continued nucleoside therapy. The results of this study suggest that receiving long-acting interferon therapy is a feasible option for nucleoside treated patients who are pursuing discontinuation of the drug. In conclusion, the discontinuation expectations of nucleoside treated patients are understandable and in line with the latest authoritative guidelines for higher requirements for the treatment of chronic hepatitis B. The choice of a scientific treatment regimen is expected to help some patients achieve this expectation.