Guidelines recommend seroclearance of hepatitis B surface antigen (HBsAg) as the desired outcome of treatment for chronic hepatitis B virus (HBV) infection. A recent systematic review and meta-analysis determined the strength of association between HBsAg seroclearance and long-term clinical outcomes.

PubMed, EMBASE, and Cochrane Library databases were searched for articles evaluating HBsAg status and reporting the incidence of hepatocellular carcinoma (HCC), liver decompensation, liver transplantation, and/or all-cause mortality during follow-up. A meta-analysis of rate ratios (RR) was done using a random effects model, independently for each endpoint, as well as a composite endpoint.

Data were analyzed from 28 studies, involving 188,316 patients with chronic HBV infection, and 1,486,081 person-years (P-Y) of follow-up. Overall, 26 studies reported data on HCC, 7 on liver decompensation, and 13 on liver transplantation and/or death. The composite event rate for the HBsAg seroclearance group was 0.19/1000 P-Y and for the HBsAg-persistent group was 2.45/1000 P-Y. Pooled RRs for the HBsAg seroclearance group were 0.28, 0.30, 0.22 and 0.31 for liver decompensation, HCC, liver transplantation and/or death, and the composite endpoint, respectively. There appeared to be no differences in RR estimates among different subgroups based on study or patient characteristics.

The systematic review and meta-analysis demonstrated that seroclearance of HBsAg had a significant association with improved patient outcomes. The results are consistent among different types of studies, and in all patient subpopulations analyzed. The findings thus favor the use of HBsAg seroclearance as a primary endpoint of trials of chronic HBV infection.

Source: Anderson RT, Choi HSJ, Lenz O, et al. Association Between Seroclearance of Hepatitis B Surface Antigen and Long-term Clinical Outcomes of Patients With Chronic HBV Infection: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020 May 27;S1542-3565(20)30748-5.