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

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.