Sex differences in treatment response to nucleos(t)ide therapy in chronic hepatitis B: a multicenter longitudinal study. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Chau, A., Yeh, M. L., Tsai, P. C., Huang, D. Q., Kim, S. E., Trinh, H., Yoon, E. L., Oh, H., Jeong, J. Y., Ahn, S. B., An, J., Tseng, C. H., Hsu, Y. C., Jeong, S. W., Cho, Y. K., Shim, J. J., Kim, H. S., Ito, T., Marciano, S., Kawashima, K., Suzuki, T., Watanabe, T., Nozaki, A., Ishikawa, T., Inoue, K., Eguchi, Y., Uojima, H., Abe, H., Takahashi, H., Chuma, M., Ishigami, M., Hoang, J. K., Mayumi, M., Huang, C. F., Gadano, A., Dai, C. Y., Huang, J. F., Tanaka, Y., Chuang, W. L., Lim, S. G., Cheung, R., Yu, M. L., Jun, D. W., Nguyen, M. H. 2023


It is unclear if there may be sex differences in response to nucleos(t)ide analogs (NA) including viral suppression [VR], biochemical response [BR], complete response [CR], and HCC incidence among hepatitis B patients. We compared NA treatment outcomes by sex.A retrospective cohort study of 3388 treatment-naïve adult hepatitis B patients (1250 female; 2138 male) from the REAL-B consortium who initiated therapy with either entecavir or tenofovir from 22 sites (Argentina, Korea, Japan, Taiwan, USA). We used propensity-score matching (PSM) to balance background characteristics of the male and female groups and competing risks analysis to estimate incidence and subdistribution hazard ratios (SHR) of VR, BR, CR, and HCC.Females (vs. males) were older (52.0 vs. 48.6 years), less likely overweight/obese (49.3% vs. 65.7%), diabetic (9.9% vs. 13.1%), or cirrhotic (27.9% vs. 33.0%), and with lower HBV DNA (5.9 vs. 6.0 log10 IU/mL) and ALT (91 vs. 102 IU/L) [all P<0.01]. However, following PSM, relevant background characteristics became balanced between the two groups. Females (vs. males) had similar 5-year cumulative VR (91.3% vs. 90.3%, P=0.40) and HCC incidence rates (5.1% vs. 4.4%, P=0.64), but lower BR (84.0% vs. 90.9%, P<0.001) and CR (78.8% vs. 83.4%, P=0.016). Males were more likely to achieve BR (SHR: 1.31, 95% CI: 1.17-1.46, P<0.001) and CR (SHR: 1.16, 95% CI: 1.03-1.31, P=0.016) but VR and HCC risks were similar.Sex differences exist for treatment outcomes among hepatitis B patients. Male sex associated with 16% higher likelihood of clinical remission and 31% higher likelihood of biochemical response than females, while viral suppression and HCC incidence were similar between the two groups.

View details for DOI 10.1016/j.cgh.2023.09.002

View details for PubMedID 37734582