NUH cures patient of Hepatitis B by stopping medication in
new trial 1

SINGAPORE: Mr Arfan Awaloeddin was suffering from Hepatitis B for about 30 years, but in May this year, he was cured.

All he had to do was stop taking his medication.  

The 49-year-old Indonesian is part of a National University Hospital (NUH) study that seeks to find out if Hepatitis B patients carrying a low amount of the markers of the viral infection have the best chances of being cured by stopping medication. 

Hepatitis B is a viral infection that affects the liver and was estimated to have been present in 180,000 people in Singapore in 2010, according to the latest figures available. 

Of the 23 people enrolled in the study that started in January, Mr Arfan is the first to be cured. The majority of them are men.

Mr Arfan was diagnosed with the disease in 1992 or 1993 in his home country, and started getting treatment in Singapore in 1996. 

Speaking to the media at a sharing session in NUH on Wednesday (Jun 12), Mr Arfan said that he was initially scared to stop his medication.

“I stopped medication on my own without asking my doctor in around 2000. I stopped for two to three months. I felt unwell, and after that I had to take medication again,” he said.

But he was reassured when his doctor, senior consultant in the Division of Gastroenterology & Hepatology, Professor Lim Seng Gee, told him he would be monitored.

Mr Arfan, who owns a hospital in Indonesia, said his father also suffered from Hepatitis B for 10 years before dying of liver cirrhosis in 2005. His three children, however, have been vaccinated against the disease.

It is a new life now for Mr Arfan.

“I feel good. I don’t have to spend money, I don’t have to take medication every morning. I feel free,” he said. He was spending about S$4,000 annually on his condition for consultation and medication, he said. 

Mr Arfan will be monitored monthly for the first year, in the three-year study. 

HOW STOPPING MEDICATION WORKS

Typically, chronic Hepatitis B patients have to be on long-term medication, which could mean taking tablets daily.

Prof Lim, the lead of the study, told the media said that when the medication is stopped, the virus will return. The patient’s immune system will then work to beat the virus. 

The virus becomes something new to the body although it has been carrying it because while the patient was on medication, the body did not recognise the virus as foreign, he explained.

“When you stop treatment, suddenly, the body realises the virus is foreign, attacks it and clears it That’s what we think is the mechanism,” said Prof Lim.

When asked if that means they did not need therapy to start with, he said no.

prof lim and mr arfan

Professor Lim Seng Gee, a senior consultant in NUH who is leading a study on stopping medication to cure Hepatitis B and Mr Arfan Awaloeddin, the patient to be cured. (Photo: Jalelah Abu Baker)

“We can’t say that, because originally, they were started on treatment because they needed it. But after 10 years, 20 years of treatment, is it time to stop? That really is the question,” he said.

How the immune system is able to clear the virus when it was not able to before is something that researchers are still trying to find out, he said.

Studies overseas have also shown that stopping medication cures Hepatitis B, but these did not focus on the amount of infection markers as a factor to find out which patients would benefit most from stopping medication, Prof Lim said.

The trial in Singapore is the only one that is targeted at patients with low levels of infection markers.

MINORITY WILL QUALIFY FOR STUDY

In order to qualify for the study here, patients have to fulfill three criteria. 

Their infection markers have to be below the level of 100, they cannot have liver cirrhosis and they have to be on oral medication, said Prof Lim. Mr Arfan’s infection marker level was just two, much lower than the cutoff of 100, when he was enrolled.

Typically, patients have levels that go into the thousands.

While it is not known how many patients have such levels of markers, Prof Lim said it would be a minority who would qualify for it.

The cutoff was based on other studies. Testing for the level of infection markers is relatively new, quite expensive and not in routine use, but patients can get tested for free as part of the study at NUH, Prof Lim said.

“We do not know how common it is, so I would encourage patients to go and get it tested,” he said.

The study, which will also start in Singapore General Hospital, Tan Tock Seng Hospital and Changi General Hospital, received S$1.5 million in funding from the National Medical Research Council. 

It will aim to enrol 150 patients. Of these, 50 will continue taking their tablets, so that the effectiveness of stopping medication can be compared against them.