Metabolic Issues May Affect Liver Fibrosis in Hepatitis B

Medscape

5 days ago

Patients with untreated chronic hepatitis B who had metabolic comorbidities were at a higher risk for advanced liver fibrosis and were less likely to see improvement with antiviral therapy than those without such comorbidities.
METHODOLOGY:
Researchers investigated the association between the presence of concurrent metabolic comorbidities and the severity of liver fibrosis in 3179 patients with untreated chronic hepatitis B (median age, 37 years; 72.2% men) using data from two tertiary clinics in the Netherlands and Canada and six global clinical trials.
All patients underwent an initial liver biopsy, and 1307 of the patients enrolled in the clinical trials underwent a second biopsy 48-72 weeks after starting antiviral therapy. Biopsies were analyzed by experienced pathologists.
Advanced fibrosis was defined as having METAVIR stages F3-F4, and nonadvanced fibrosis as having METAVIR stages F0-F2. Progression or regression of fibrosis was determined by an increase or decrease in fibrosis of at least one METAVIR stage from baseline, respectively.
The presence of metabolic comorbidities (overweight, hypertension, diabetes, and dyslipidemia) was assessed using chart reviews and patient histories.
TAKEAWAY:
At baseline, metabolic comorbidities were present in 54.8% of patients, and advanced fibrosis was present in 24.4% of patients.
The presence of metabolic comorbidities was independently associated with an increased risk for advanced fibrosis (adjusted odds ratio [aOR] for one comorbidity, 1.115; aOR for two or more comorbidities, 1.627; P = .006).
= .006). The presence of metabolic comorbidities was also independently associated with reduced odds of regression from advanced to nonadvanced fibrosis after initiating antiviral therapy (aOR for one comorbidity, 0.79; aOR for two or more comorbidities, 0.26; P = .025).
= .025). Progression to advanced fibrosis during antiviral therapy was observed in 9.8% of patients with one metabolic comorbidity and 14.3% of those with two or more metabolic comorbidities compared with 4.6% of those without metabolic comorbidities ( P = .001).
IN PRACTICE:
'These findings provide solid support for the recently published World Health Organization HBV [hepatitis B virus] guideline, which underlines the importance of identifying and managing metabolic comorbidities in CHB [chronic hepatitis B] patients, as these comorbidities increase the risk of fibrosis progression and HCC [hepatocellular carcinoma] development,' the study authors wrote.
SOURCE:
The study, led by Lisa M. van Velsen, MD, Department of Gastroenterology & Hepatology, Erasmus Medical Center in Rotterdam, the Netherlands, was published online in Clinical Gastroenterology and Hepatology .
LIMITATIONS:
Information on hepatic steatosis was unavailable for the clinical trial patients. The presence of metabolic comorbidities was determined on the basis of a retrospective review of medical histories and medications, potentially leading to underdiagnosis of the conditions. Changes or development of metabolic comorbidities during follow-up could not be accounted for.
DISCLOSURES:
This study was sponsored by the Foundation for Liver and Gastrointestinal Research, and the data for the analyses were shared by Roche and Gilead Sciences. Several authors reported receiving research support or grants, consulting and/or speaking fees, honoraria, or contracts from pharmaceutical and biotechnology companies, including Roche and Gilead Sciences. One author reported being employed by Roche, and two authors reported being employed by Gilead Sciences.