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한양대학교 의과대학

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Clin. Gastroenterol. Hepatol., Sep 19 2023, S1542-3565(23)00713-9 | https://doi.org/10.1016/j.cgh.2023.09.002 Sex differences in treatment response to nucleos(t)ide therapy in chronic hepatitis B: a multicenter longitudinal study.

Angela Chau¹, Ming-Lun Yeh ^2,3, Pei-Chien Tsai ^2,3, Daniel Q. Huang ^4,5, Sung Eun Kim ⁶, Huy Trinh ⁷, Eileen L. Yoon ^8,9, Hyunwoo Oh ¹⁰, Jae Yoon Jeong ¹¹, Sang Bong Ahn¹², Jihyun An ¹¹, Cheng-Hao Tseng ¹³, Yao-Chun Hsu ¹³, Soung Won Jeong ¹⁴, Yong Kyun Cho ¹⁵, Jae-Jun Shim ¹⁶, Hyoung Su Kim ¹⁷, Takanori Ito ¹⁸, Sebastián Marciano ¹⁹, Keigo Kawashima ²⁰, Takanori Suzuki ²¹, Tsunamasa Watanabe ²², Akito Nozaki ²³, Toru Ishikawa ²⁴, Kaori Inoue ²⁵, Yuichiro Eguchi ^25,26, Haruki Uojima ²⁷, Hiroshi Abe ²⁸, Hirokazu Takahashi ^25,29, Makoto Chuma ²², Masatoshi Ishigami ¹⁸, Joseph K. Hoang ¹, Maeda Mayumi¹, Chung-Feng Huang ^2,3, Adrian Gadano ¹⁹, Chia-Yen Dai^2,3, Jee-Fu Huang^2,3, Yasuhito Tanaka ³⁰, Wan-Long Chuang ^2,3, Seng Gee Lim^4,5, Ramsey Cheung ¹, Ming-Lung Yu ^2,31, Dae-Won Jun³², Mindie H. Nguyen ¹

¹Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States

²Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

³Hepatitis Research Center, College of Medicine and Cohort Research Center, Kaohsiung Medical University, Kaohsiung

⁴Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore

⁵Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

⁶Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang

⁷San Jose Gastroenterology, San Jose, CA

⁸Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul

9Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul

¹⁰Division of Gastroenterology, Department of Internal Medicine,Uijeongbu Eulji Medical Center, Eulji University School of Medicine

¹¹Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri

¹²Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul

¹³Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan

¹⁴Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul

¹⁵Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul

¹⁶Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul

¹⁷Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

¹⁸Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine

¹⁹Hepatología and Departamento de Investigación, Hospital Italiano de Buenos Aires, Argentina

²⁰Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

²¹Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

²²Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki

²³Gastroenterological Center, Yokohama City University Medical Center, Yokohama

²⁴Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata

²⁵Liver Center, Saga University Hospital, Saga

²⁶Locomedical General Institute, Locomedical Eguchi Hospital, Saga

²⁷Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara

²⁸Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Chiba

²⁹Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga

³⁰Department of Gastroenterology and Hepatology, Kumamoto University, Kumamoto, Japan

³¹School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan

³²Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul

Correspondence: Dae Won Jun, MD, PhD, Mindie H. Nguyen, MD, MAS

Abstract

Background: 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.

Approach: 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.

Results: 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.

Conclusions: 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.

논문정보

형식Research article
게재일2023년 09월 (BRIC 등록일 2023-09-27)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

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