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
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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%, <i>P</i> < 0.001) and CR rates (81.8% vs. 87.4%, <i>P</i> = 0.008), but similar VR (93.5% vs. 94.1%, <i>P</i> = 0.65) and HBeAg seroconversion rates (27.0% vs. 29.7%, <i>P</i> = 0.92). On multivariable Cox regression, metabolic disease was associated with lower BR (adjusted hazard ratio [aHR] 0.73, <i>P</i> < 0.001) and CR (aHR 0.79, <i>P</i> = 0.001), especially in those with ≥3 metabolic diseases (aHR 0.55 for BR; aHR 0.53 for CR, both <i>P</i> < 0.001).</p><p><strong>Interpretation: </strong>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.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"87 ","pages":"103407"},"PeriodicalIF":10.0000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359161/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of metabolic dysfunction on treatment responses to nucleos(t)ide analogues in chronic hepatitis B: a retrospective multi-center REAL-B cohort study.\",\"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\",\"doi\":\"10.1016/j.eclinm.2025.103407\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>More than half (54.8%) had at least one metabolic disease. 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引用次数: 0
摘要
背景：代谢功能障碍与肝脏疾病有关，但尚不清楚它是否会影响慢性乙型肝炎（CHB）患者对抗病毒治疗的反应。方法：利用2004年1月至2024年8月来自32个中心的4507名treatment-naïve CHB患者的国际联盟数据和倾向评分匹配（PSM）来平衡有和没有代谢性疾病（糖尿病、肥胖、血脂异常或高血压）的患者的背景，我们比较了他们的生化（BR）、病毒学（VR）和完全（CR）反应。结果：超过一半（54.8%）至少患有一种代谢性疾病。代谢性疾病患者年龄较大，男性居多。在893对PSM患者队列中，代谢性疾病患者的5年累积BR （91.3% vs. 95.8%, P < 0.001）和CR率（81.8% vs. 87.4%, P = 0.008）显著降低，但VR （93.5% vs. 94.1%, P = 0.65）和HBeAg血清转化率（27.0% vs. 29.7%, P = 0.92）相似。在多变量Cox回归中，代谢性疾病与较低的BR（校正风险比[aHR] 0.73, P < 0.001）和CR （aHR 0.79, P = 0.001）相关，特别是在≥3种代谢性疾病的患者中（BR的aHR为0.55，CR的aHR为0.53，均P < 0.001）。解释：代谢性疾病的存在和数量与低BR呈显著递增关系。在接受NAs治疗的慢性乙型肝炎患者的管理中应考虑到代谢性疾病。资金:没有。
Impact of metabolic dysfunction on treatment responses to nucleos(t)ide analogues in chronic hepatitis B: a retrospective multi-center REAL-B cohort study.
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.
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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