To test the concept that off‐therapy hepatitis flares with increasing qHBsAg require immediate re‐treatment whereas re‐treatment can be held or not necessary for those with decreasing qHBsAg, pre‐retreatment combined HBsAg/ALT kinetics were classified in 22 patients with severe hepatitis flare (ALT > 30X ULN) and checked against their clinical response and qHBsAg changes during entecavir re‐treatment. Timely re‐treatment in 16 patients with increasing qHBsAg during hepatitis flare (Pattern I HBV/ALT kinetics) not only improved hepatitis and rescued impending/ensuring hepatic decompensation but also led to ‘rapid HBsAg decline’ with 14 patients showing HBsAg decline >1‐4 log10 IU/mL within 12 months. In contrast, re‐treatment in 6 patients with decreasing qHBsAg (Pattern II) resulted in small HBsAg decline in one patient and initial further HBsAg decline but rebound to pre‐retreatment level in 3 patients. Of note, stopping 8‐day re‐treatment in a patient with pre‐retreatment HBsAg decline >1 log10 IU/mL allowed further HBsAg decline to a low level (4 IU/mL) towards HBsAg loss. These findings suggest that immediate re‐treatment is appropriate in severe hepatitis flare with Pattern I HBsAg/ALT kinetics but can be held or even not necessary in those with Pattern II HBsAg/ALT kinetics. Serial qHBsAg assays, more frequently during hepatitis flare, are helpful for re‐treatment decision and close monitoring is mandatory to start, to hold or to stop re‐treatment in patients with hepatitis flare.