Impact of Concurrent Steatotic Liver Disease and Chronic Hepatitis B on Treatment Response to Nucleos(t)ide Analogs

Data is limited regarding response to nucleos(t)ide analogs (NA) among patients with concurrent steatotic liver disease (SLD) and chronic hepatitis B (CHB). We investigated the outcomes of NA therapy between SLD-CHB and non-SLD CHB patients in a multinational CHB cohort. Adult CHB patients treated with ETV, TDF, or TAF from 28 sites (United States, Taiwan, Japan, Korea, China, Singapore, Argentina) were retrospectively analysed. SLD was diagnosed by imaging. Propensity score matching (PSM) was used to balance the SLD-CHB and non-SLD CHB groups, and competing risks analysis was used to compare incidence and sub-distribution hazard ratios (SHRs) of VR, BR, and CR. The study included 4600 patients (26.7% with SLD). SLD-CHB patients (vs. non-SLD CHB) were younger (49.4 vs. 50.9 years, p < 0.001), more likely male (68.0% vs. 61.6%), from the West (24.9% vs. 19.3%), and with higher BMI (25.3 vs. 23.5) but less likely to have advanced fibrosis (22.6% vs. 35.9%), all p < 0.001. Following PSM, baseline characteristics became balanced between the two groups. The 5-year cumulative rates for the SLD-CHB versus non-SLD CHB groups were as follows: VR (87.9% vs. 89.8%, p = 0.16), BR (86.8% vs. 89.2%, p = 0.096), and CR (77.5% vs. 81.0%, p = 0.085). After multivariable analysis, SLD-CHB patients had a significantly lower likelihood of achieving BR (SHR = 0.77, CI: 0.68-0.88, p < 0.001) and CR (SHR = 0.84, CI: 0.72-0.97, p = 0.019), but not VR. Among CHB patients treated with NA therapy, SLD was associated with a 23% lower likelihood of biochemical response and a 16% lower likelihood of complete response but did not impact virologic response.