Impact of metabolic dysfunction on treatment responses to nucleos(t)ide analogues in chronic hepatitis B: a retrospective multi-center REAL-B cohort studyResearch in context

Impact of metabolic dysfunction on treatment responses to nucleos(t)ide analogues in chronic hepatitis B: a retrospective multi-center REAL-B cohort studyResearch in context

Summary: Background: Metabolic dysfunction is associated with liver disease but it is unclear if it would impact responses to antiviral treatment in chronic hepatitis B (CHB) patients. Methods: Using data from an international consortium of 4507 treatment-naïve CHB patients who initiated nucleos(t)...

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Main Authors: Rui Huang, Dae Won Jun, Hidenori Toyoda, Yao-Chun Hsu, Huy Trinh, Akito Nozaki, Toru Ishikawa, Tsunamasa Watanabe, Haruki Uojima, Daniel Q. Huang, Takashi Honda, Yasuhito Tanaka, Philip Vutien, Sebastián Marciano, Hiroshi Abe, Masaru Enomoto, Masanori Atsukawa, Hirokazu Takahashi, Kunihiko Tsuji, Ei Itobayashi, Koichi Takaguchi, Pei-Chien Tsai, Chia-Yen Dai, Jee-Fu Huang, Chung-Feng Huang, Ming-Lun Yeh, Eileen Yoon, Sung Eun Kim, Sang Bong Ahn, Gi-Ae Kim, Jang Han Jung, Soung Won Jeong, Hyunwoo Oh, Cheng-Hao Tseng, Masatoshi Ishigami, Angela Chau, Tiffany Hsiao, Mayumi Maeda, Satoshi Yasuda, Makoto Chuma, Takanori Ito, Keigo Kawashima, Joanne Kimiko Liu, Adrian Gadano, Ritsuzo Kozuka, Norio Itokawa, Kaori Inoue, Tomonori Senoh, Jie Li, Wan-Long Chuang, Ramsey Cheung, Chao Wu, Ming-Lung Yu, Mindie H. Nguyen
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:EClinicalMedicine
Subjects:
Chronic hepatitis B
Metabolic diseases
Treatment response
Nucleos(t)ide analogues
Online Access:http://www.sciencedirect.com/science/article/pii/S2589537025003396
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Summary:Summary: Background: Metabolic dysfunction is associated with liver disease but it is unclear if it would impact responses to antiviral treatment in chronic hepatitis B (CHB) patients. Methods: Using data from an international consortium of 4507 treatment-naïve CHB patients who initiated nucleos(t)ide analogues (NAs) between January 2004 and August 2024 from 32 centers and propensity-score matching (PSM) to balance the background of patients with and without metabolic disease (diabetes, obesity, dyslipidemia, or hypertension), we compared their biochemical (BR), virologic (VR), and complete (CR) response. Findings: More than half (54.8%) had at least one metabolic disease. Patients with metabolic disease (vs. no) were older and more likely male. In the PSM cohort of 893 pairs of patients, patients with metabolic disease had significantly lower 5-year cumulative BR (91.3% vs. 95.8%, P < 0.001) and CR rates (81.8% vs. 87.4%, P = 0.008), but similar VR (93.5% vs. 94.1%, P = 0.65) and HBeAg seroconversion rates (27.0% vs. 29.7%, P = 0.92). On multivariable Cox regression, metabolic disease was associated with lower BR (adjusted hazard ratio [aHR] 0.73, P < 0.001) and CR (aHR 0.79, P = 0.001), especially in those with ≥3 metabolic diseases (aHR 0.55 for BR; aHR 0.53 for CR, both P < 0.001). Interpretation: The presence and number of metabolic diseases were significantly and incrementally associated with lower BR. Metabolic disease should be taken into consideration in the management of CHB patients receiving NAs treatment. Funding: None.
ISSN:2589-5370

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