Impact of Concurrent Steatotic Liver Disease and Chronic Hepatitis B on Treatment Response to Nucleos(t)ide Analogs

Data is limited regarding response to nucleos(t)ide analogs (NA) among patients with concurrent steatotic liver disease (SLD) and chronic hepatitis B (CHB). We investigated the outcomes of NA therapy between SLD-CHB and non-SLD CHB patients in a multinational CHB cohort. Adult CHB patients treated with ETV, TDF, or TAF from 28 sites (United States, Taiwan, Japan, Korea, China, Singapore, Argentina) were retrospectively analysed. SLD was diagnosed by imaging. Propensity score matching (PSM) was used to balance the SLD-CHB and non-SLD CHB groups, and competing risks analysis was used to compare incidence and sub-distribution hazard ratios (SHRs) of VR, BR, and CR. The study included 4600 patients (26.7% with SLD). SLD-CHB patients (vs. non-SLD CHB) were younger (49.4 vs. 50.9 years, p < 0.001), more likely male (68.0% vs. 61.6%), from the West (24.9% vs. 19.3%), and with higher BMI (25.3 vs. 23.5) but less likely to have advanced fibrosis (22.6% vs. 35.9%), all p < 0.001. Following PSM, baseline characteristics became balanced between the two groups. The 5-year cumulative rates for the SLD-CHB versus non-SLD CHB groups were as follows: VR (87.9% vs. 89.8%, p = 0.16), BR (86.8% vs. 89.2%, p = 0.096), and CR (77.5% vs. 81.0%, p = 0.085). After multivariable analysis, SLD-CHB patients had a significantly lower likelihood of achieving BR (SHR = 0.77, CI: 0.68-0.88, p < 0.001) and CR (SHR = 0.84, CI: 0.72-0.97, p = 0.019), but not VR. Among CHB patients treated with NA therapy, SLD was associated with a 23% lower likelihood of biochemical response and a 16% lower likelihood of complete response but did not impact virologic response.

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Publication Details

Journal
Journal of Viral Hepatitis
Published
2025-09-13
DOI
https://doi.org/10.1111/jvh.70081
Primary Topic
Liver Disease Diagnosis and Treatment
Type
article
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article

Impact of Concurrent Steatotic Liver Disease and Chronic Hepatitis B on Treatment Response to Nucleos(t)ide Analogs

Gi‐Ae Kim, Pei‐Chien Tsai, Takashi Honda, Rui Huang et al.
Journal of Viral Hepatitis
Liver Disease Diagnosis and Treatment
article

Impact of Concurrent Steatotic Liver Disease and Chronic Hepatitis B on Treatment Response to Nucleos(t)ide Analogs

Gi‐Ae Kim, Pei‐Chien Tsai, Takashi Honda, Rui Huang, Seng Gee Lim, Norio Itokawa, Daniel Q. Huang, Wan‐Long Chuang, Yasuhito Tanaka, Keigo Kawashima, Cheng‐Hao Tseng, Tiffany Hsiao, Ramsey Cheung, Hidenori Toyoda, Adrian Carlos Gadano, Makoto Chuma, Jang Han Jung, Yao‐Chun Hsu, Tomonori Senoh, Kunihiko Tsuji, Mindie H. Nguyen, Dae Won Jun, Eileen Laureal Yoon, Chia‐Yen Dai, Jee‐Fu Huang, Ritsuzo Kozuka, Hyunwoo Oh, Ei Itobayashi, Philip Vutien, Ming‐Lun Yeh, Sebastián Marciano, Chung‐Feng Huang, Sang Bong Ahn, Masatoshi Ishigami, Soung Won Jeong, Ming‐Lung Yu, Toru Ishikawa, Takanori Ito, Akito Nozaki, Masanori Atsukawa, Angela Chau, Tsunamasa Watanabe, Mayumi Maeda, Koichi Takaguchi, Masaru Enomoto, Sung Eun Kim, Jie Li, Hirokazu Takahashi, Haruki Uojima, Hiroshi Abe, Satoshi Yasuda, Joanne Kimiko Liu, Huy Trinh, Kaori Inoue, Chao Wu
article en

Abstract

Data is limited regarding response to nucleos(t)ide analogs (NA) among patients with concurrent steatotic liver disease (SLD) and chronic hepatitis B (CHB). We investigated the outcomes of NA therapy between SLD-CHB and non-SLD CHB patients in a multinational CHB cohort. Adult CHB patients treated with ETV, TDF, or TAF from 28 sites (United States, Taiwan, Japan, Korea, China, Singapore, Argentina) were retrospectively analysed. SLD was diagnosed by imaging. Propensity score matching (PSM) was used to balance the SLD-CHB and non-SLD CHB groups, and competing risks analysis was used to compare incidence and sub-distribution hazard ratios (SHRs) of VR, BR, and CR. The study included 4600 patients (26.7% with SLD). SLD-CHB patients (vs. non-SLD CHB) were younger (49.4 vs. 50.9 years, p < 0.001), more likely male (68.0% vs. 61.6%), from the West (24.9% vs. 19.3%), and with higher BMI (25.3 vs. 23.5) but less likely to have advanced fibrosis (22.6% vs. 35.9%), all p < 0.001. Following PSM, baseline characteristics became balanced between the two groups. The 5-year cumulative rates for the SLD-CHB versus non-SLD CHB groups were as follows: VR (87.9% vs. 89.8%, p = 0.16), BR (86.8% vs. 89.2%, p = 0.096), and CR (77.5% vs. 81.0%, p = 0.085). After multivariable analysis, SLD-CHB patients had a significantly lower likelihood of achieving BR (SHR = 0.77, CI: 0.68-0.88, p < 0.001) and CR (SHR = 0.84, CI: 0.72-0.97, p = 0.019), but not VR. Among CHB patients treated with NA therapy, SLD was associated with a 23% lower likelihood of biochemical response and a 16% lower likelihood of complete response but did not impact virologic response.

Journal of Viral HepatitisVol. 32(10)
National Sun Yat-sen University (TW), Kaohsiung Medical University (TW), St. Marianna University School of Medicine (JP), National University of Singapore (SG), Saga University (JP), University of Washington (US), VA Palo Alto Health Care System (US), Cornell University (US), Eulji University (KR), Soonchunhyang University Hospital Seoul (KR), Yokohama City University Medical Center (JP), Hospital Italiano de Buenos Aires (AR), Kaohsiung Medical University Chung-Ho Memorial Hospital (TW), Nagoya City University (JP), Kyung Hee University (KR), E-Da Hospital (TW), National Center for Global Health and Medicine (JP), Kangbuk Samsung Hospital (KR), Stanford Health Care (US), Saiseikai Niigata Daini Hospital (JP), Nanjing Drum Tower Hospital (CN), Ogaki Municipal Hospital (JP), Hodogaya Chemical (Japan) (JP), Shinmatsudo Central General Hospital (JP), Stanford Medicine (US), Teine Keijinkai Hospital (JP), Asahi General Hospital (JP), National University Hospital (SG), Hallym University Dongtan Sacred Heart Hospital (KR), Kagawa Prefectural Central Hospital (JP), Kaiser Permanente San Jose Medical Center (US), Hallym University Sacred Heart Hospital (KR), Universidad Hospital Italiano (AR), Osaka Metropolitan University (JP), Weill Cornell Medicine (US), Hanyang University (KR), Nagoya University (JP), Kitasato University (JP), Tokyo Metropolitan University (JP), Nippon Medical School (JP), Sungkyunkwan University (KR), Yokohama City University (JP), Kumamoto University (JP), Stanford University (US), I-Shou University (TW)
National Sun Yat-sen University, Sun Yat-sen University, Ministry of Education, India, National Science and Technology Council
Openalex Percentile: Top 67%
Liver Disease Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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