Response to nucleos(t)ide analogues for hepatitis B higher among men vs women

Treatment outcomes with nucleos(t)ide analogues for hepatitis B patients appear to differ by sex, such that men are more likely to have biochemical response and achieve clinical remission than women, a study has shown.

For the study, researchers used data from the REAL-B consortium and reviewed the medical records of 3,388 treatment-naïve adult hepatitis B patients (1250 female; 2138 male) who initiated therapy with either entecavir or tenofovir.

Propensity-score matching (PSM) was applied to balance background characteristics of the male and female patients, while competing risks analysis was used to estimate incidence and subdistribution hazard ratios (SHR) of outcomes including viral suppression, biochemical response, complete response, and hepatocellular carcinoma (HCC) incidence.

Compared with men, women were older (52.0 vs 48.6 years) and less likely overweight/obese (49.3 percent vs 65.7 percent), diabetic (9.9 percent vs 13.1 percent), or cirrhotic (27.9 percent vs 33.0 percent). Additionally, women had significantly lower HBV DNA (5.9 vs 6.0 log10 IU/mL) and alanine transaminase (ALT) levels (91 vs 102 IU/L; p<0.01 for all comparisons).

Following PSM, relevant background characteristics became balanced between the two groups.

In terms of treatment outcomes, female patients had significantly lower rates of biochemical response (84.0 percent vs 90.9 percent; p<0.001) and complete response (78.8 percent vs 83.4 percent; p=0.016) compared with male patients. However, no significant difference was noted in the 5-year cumulative rates of viral suppression (91.3 percent vs 90.3 percent; p=0.40) and HCC incidence (5.1 percent vs 4.4 percent; p=0.64).

Further analysis showed that male sex was associated with a 31-percent and 16-percent higher likelihood of achieving biochemical response (SHR, 1.31, 95 percent confidence interval [CI], 1.17–1.46; p<0.001) and clinical remission (SHR, 1.16, 95 percent CI, 1.03–1.31; p=0.016), respectively.