ReviewThe lancet. Gastroenterology & hepatology2020
Serum alanine aminotransferase flares in chronic hepatitis B infection: the good and the bad.
Review in The lancet. Gastroenterology & hepatology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
66 citing papers in PubMed, 1 synthesis or guideline pooled it.
- [Chinese expert consensus on clinical practice of chronic hepatitis B functional (clinical) cure].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Guideline
- Hepatic flares, their immune signatures, and ALT variability after nucleos(t)ide analogue cessation in HBeAg-negative hepatitis B.JHEP reports : innovation in hepatology · 2026Trial
- Long-Term Follow-Up of Patients in a Prospective Study of NA Discontinuation Identifies Different Patterns of HBsAg Loss.Alimentary pharmacology & therapeutics · 2026Trial
- Frequency, Severity and Impact of Pegylated Interferon Alpha-Associated Flares in Hepatitis D Infection.Journal of viral hepatitis · 2025Trial
- Farnesoid X receptor agonist for the treatment of chronic hepatitis B: A safety study.Journal of viral hepatitis · 2021Trial
- Immune Control, HBsAg Loss or Flare Requiring Liver Transplant-Diverse Outcomes After Stopping NUC Therapy.Viruses · 2026Article
- A serum Golgi Protein 73 (GP73)-based model for evaluating inflammation associated with drug-induced liver injury.Clinics (Sao Paulo, Brazil) · 2026Article
- Severe hepatitis B flare and liver failure: current assessment and management.Clinical and molecular hepatology · 2026Review
- Hepatitis B treatment response and factors associated with HBV treatment success: A population-based study in Rwanda.Hepatology communications · 2026Article
- Article
- Anti-HBc IgM associates with acute flare and HBeAg/HBsAg loss in chronic hepatitis B patients with acute exacerbation.Virulence · 2025Article
- High HBsAg clearance rate and viral dynamics in HBeAg-positive, ALT-normal children and adolescents with chronic HBV infection: results from the prospective sprout project.Emerging microbes & infections · 2025Article
- Chemotherapy drugs do not affect the production of hepatitis B surface antibodies: A case report.Oncology letters · 2025Article
- Estrogen protects against postpartum Concanavalin A-induced hepatitis by promoting intrahepatic CD4⁺CD25⁺ Treg expansion through activation of the PI3K/Akt signaling pathway in HBV-Tg mice.Virology journal · 2025Article
- HBV-specific T-cell function is nonenhanced by tenofovir-induced decline in HBV viremia or HBsAg titer in chronic hepatitis B.Hepatology communications · 2025Article
- Sequential combination with ropeginterferon alfa-2b and anti-PD-1 treatment as adjuvant therapy in HBV-related HCC: a phase 1 dose escalation trial.Hepatology international · 2025Article
- Chronic Hepatitis B Patients Referred for Liver Transplantation After Nucleos(t)ide Analog Cessation.Journal of viral hepatitis · 2025Article
- Multi-omics reveals the associations among the fecal metabolome, intestinal bacteria, and serum indicators in patients with hepatocellular carcinoma.World journal of gastroenterology · 2025Article
- Unexpected HBsAg decrease after nucleoside analogues retreatment among HBeAg positive postpartum women: a pilot study.Virology journal · 2025Observational
- Characteristics and mechanisms of liver injury caused by emerging infectious diseases.Frontiers in immunology · 2025Review
6 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
Chronic hepatitis B virus (HBV) infection follows a dynamic and variable course. At different stages in the disease, hepatitis flares might occur, which can be challenging to predict and manage. Flares are believed to be primarily immune-mediated and might mark transitions to inactive disease or clearance of infection, but in certain scenarios they might also lead to hepatic decompensation or death. As such, understanding of the clinical significance of flares in different patient populations and different scenarios is important for optimal management. In this Review, we summarise what is known about flares in different stages of chronic HBV infection; describe flares in the context of the natural history of chronic infection; summarise the immunological mechanisms underlying flares, and describe flares in different clinical scenarios. Each section reviews existing knowledge and highlights key unanswered questions that need to be addressed to improve the understanding of flares, hopefully providing insights into their pathogenesis that can be used to improve current clinical management and ideally to further develop new curative therapeutic approaches for HBV infection. We also propose a working definition of an ALT flare to facilitate future research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.