Steatosis and Interferon Associated with HBsAg Immune Control in Chronic Hepatitis B: A Real-World Propensity Score-Matched Study

TL;DR

This study finds that people with fatty liver or interferon treatment are more likely to achieve immune control in chronic hepatitis B.

Contribution

The study identifies steatosis and interferon treatment as baseline predictors of HBsAg immune control in chronic hepatitis B patients.

Findings

Steatosis and interferon treatment were significantly associated with functional cure in chronic hepatitis B patients.

Monotherapy or add-on therapy with interferon outperformed switching to nucleos(t)ide analogs.

De novo combination therapy did not show better outcomes compared to other regimens.

Abstract

Background/Objectives: The baseline determinants of functional cure in chronic hepatitis B (CHB) are largely unknown. By applying propensity score matching (PSM) to real-world data, we aimed to identify traits associated with functional cure. Methods: We included CHB cases which achieved a functional cure and randomly selected non-achievers from patients followed from 2000 to 2020. Initial screening of baseline candidate traits was conducted using PSM-balanced cases and controls. Subsequently, through multiple rounds of leave-one-covariate-out on the balanced cohorts, we validated the impact of these traits using survival analysis. Results: In total, 85 cases (mean age: 35.78; female/male: 23/62) were compared with 247 controls (mean age: 37.08; female/male: 80/167, out of 3666), with a median follow-up of 69.56 months. Steatosis and interferon (IFN) treatment were significantly more frequent in the cases, as confirmed by forest plots showing significant hazard ratios. During validation, whether through balancing all covariates or leave-one-covariate-out matching, both steatosis and exposure to IFN resulted in a higher number of functional cures and HBsAg seroconversions. Further comparisons revealed that add-on or monotherapy outperformed switching (from IFN to NUC), while the de novo (IFN + NUC, followed by NUC) approach was not observed. Conclusions: We confirmed that individuals with steatosis at baseline or those who received IFN were more likely to achieve HBsAg immune control, with monotherapy/add-on therapy being emphasized.

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