Real-world hepatitis B antiviral treatment trends and adherence to practice guidelines: a large cohort study

ABSTRACT

Background

Epidemiologic data regarding chronic hepatitis B virus infections in Israel is limited as extensive population-based studies have not been performed.

Objective

This work aimed to evaluate the current characteristics of hepatitis B infection among Israeli adults and evaluate adherence to the European Association for the Study of the Liver practice guidelines for antiviral treatment.

Methods

Clinical and demographic data of HBsAg-positive patients registered in the Leumit-Health-Service database (one of the four major health maintenance organizations in Israel) between 2000 and 2019 were retrieved. Patients were compared according to eligibility to antiviral treatment and type of nucleos(t)ide analogue (NA) treatment.

Results

In total, 1216 patients had documented HBsAg positivity (males 58.6%, mean age 40.2 ± 14.2 years), 90.6% of whom were HBeAg negative. Antiviral therapy eligibility was met by 37% of patients, among whom 89% received antiviral therapy. Antiviral therapies include NA with a high barrier to resistance (HBR) (64.5%) and NA with a low barrier to resistance (LBR) (35.5%). Compared to patients who received LBR NA, patients receiving HBR NA had shorter treatment (68.7 ± 50 vs. 161.5 ± 42.6 months, p < .001) and follow-up duration (125 ± 68 vs. 188 ± 48 months, p < .001); at the end of follow-up, ALT levels and APRI score were higher among patients on LBR NA compared to patients on HBR NA.

Conclusion

Most patients received antiviral treatment according to the international practice guidelines. However, one-third of them were treated with a less potent NA, probably due to their lower cost. These findings should encourage the optimization of HBV care and full compliance with the professional practice guideline recommendations.

KEYWORDS:

• Antiviral therapy
• adherence to guidelines
• chronic hepatitis B
• eligibility for antiviral treatment
• high barrier to resistance

Abbreviations

ALT, alanine aminotransferase; AASLD American Association for the Study of the Liver; AST, aspartate transaminase; APRI, AST-to-Platelet Ratio Index; BMI, body mass index; CHB, chronic hepatitis B virus; CHBI, chronic HBV infection; EASL, European Association for the Study of the Liver; FIB-4, Fibrosis-4; HCC, hepatocellular carcinoma; HCV Ab, hepatitis C antibody; HDV Ab, hepatitis D antibody; HBeAg -, Hepatitis B e Antigen negative; HBeAg, Hepatitis B e Antigen; HBeAb +, Hepatitis B e antibody positive; HBsAg, hepatitis B surface antigen; HBR, high barrier to resistance; INR, international normalized ratio; LBR, low barrier to resistance; LHS, Leumit-Health-Service; NA, nucleos(t)ide analogues; SD, standard deviation; ULN, upper limit normal.

Disclosure statement

No potential conflict of interest was reported by the author(s).