Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies

Iain A. Gillespie; Eleanor Barnes; Ian C.K. Wong; Philippa C. Matthews; Graham S. Cooke; Craig Tipple; Robert C. Elston; Yunhao Liu; David A. Smith; Tingyan Wang; Jim Davies; Kinga A. Várnai; Oliver Freeman; Kenneth K.C. Man; Wallis C.Y. Lau; Ben Glampson; Xing Meng; Eleonora Morais; Sen Liu; Luca Mercuri; Naomi Boxall; Sarah Jenner; Stuart Kendrick; Jane Dong; Dickens Theodore

doi:10.1007/s40121-023-00824-y

Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies

Iain A. Gillespie^*, Eleanor Barnes, Ian C.K. Wong, Philippa C. Matthews, Graham S. Cooke, Craig Tipple, Robert C. Elston, Yunhao Liu, David A. Smith, Tingyan Wang, Jim Davies, Kinga A. Várnai, Oliver Freeman, Kenneth K.C. Man, Wallis C.Y. Lau, Ben Glampson, Xing Meng, Eleonora Morais, Sen Liu, Luca MercuriNaomi Boxall, Sarah Jenner, Stuart Kendrick, Jane Dong, Dickens Theodore

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients’ demographic, clinical and biochemical characteristics across three continents and their associated treatment need. Methods: This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). Results: In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9–49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3–66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. Conclusion: This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.

Original language	English
Pages (from-to)	2513-2532
Number of pages	20
Journal	Infectious Diseases and Therapy
Volume	12
Early online date	11 Jul 2023
DOIs	https://doi.org/10.1007/s40121-023-00824-y
Publication status	E-pub ahead of print - 11 Jul 2023

Bibliographical note

This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any
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Keywords

Antiviral treatment
Epidemiology
Treatment status
Undertreatment

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10.1007/s40121-023-00824-yLicence: CC BY-NC 4.0

Patient biochemistry and treatment need in chronic hepatitis B virus infection across three continents
This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/.
Final published version, 618 KBLicence: CC BY-NC 4.0

Cite this

Gillespie, I. A., Barnes, E., Wong, I. C. K., Matthews, P. C., Cooke, G. S., Tipple, C., Elston, R. C., Liu, Y., Smith, D. A., Wang, T., Davies, J., Várnai, K. A., Freeman, O., Man, K. K. C., Lau, W. C. Y., Glampson, B., Meng, X., Morais, E., Liu, S., ... Theodore, D. (2023). Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies. Infectious Diseases and Therapy, 12, 2513-2532. Advance online publication. https://doi.org/10.1007/s40121-023-00824-y

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title = "Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies",

abstract = "Introduction: Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients{\textquoteright} demographic, clinical and biochemical characteristics across three continents and their associated treatment need. Methods: This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). Results: In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9–49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3–66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. Conclusion: This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.",

keywords = "Antiviral treatment, Epidemiology, Treatment status, Undertreatment",

author = "Gillespie, {Iain A.} and Eleanor Barnes and Wong, {Ian C.K.} and Matthews, {Philippa C.} and Cooke, {Graham S.} and Craig Tipple and Elston, {Robert C.} and Yunhao Liu and Smith, {David A.} and Tingyan Wang and Jim Davies and V{\'a}rnai, {Kinga A.} and Oliver Freeman and Man, {Kenneth K.C.} and Lau, {Wallis C.Y.} and Ben Glampson and Xing Meng and Eleonora Morais and Sen Liu and Luca Mercuri and Naomi Boxall and Sarah Jenner and Stuart Kendrick and Jane Dong and Dickens Theodore",

note = "This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/.",

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doi = "10.1007/s40121-023-00824-y",

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Gillespie, IA, Barnes, E, Wong, ICK, Matthews, PC, Cooke, GS, Tipple, C, Elston, RC, Liu, Y, Smith, DA, Wang, T, Davies, J, Várnai, KA, Freeman, O, Man, KKC, Lau, WCY, Glampson, B, Meng, X, Morais, E, Liu, S, Mercuri, L, Boxall, N, Jenner, S, Kendrick, S, Dong, J & Theodore, D 2023, 'Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies', Infectious Diseases and Therapy, vol. 12, pp. 2513-2532. https://doi.org/10.1007/s40121-023-00824-y

TY - JOUR

T1 - Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies

AU - Gillespie, Iain A.

AU - Barnes, Eleanor

AU - Wong, Ian C.K.

AU - Matthews, Philippa C.

AU - Cooke, Graham S.

AU - Tipple, Craig

AU - Elston, Robert C.

AU - Liu, Yunhao

AU - Smith, David A.

AU - Wang, Tingyan

AU - Davies, Jim

AU - Várnai, Kinga A.

AU - Freeman, Oliver

AU - Man, Kenneth K.C.

AU - Lau, Wallis C.Y.

AU - Glampson, Ben

AU - Meng, Xing

AU - Morais, Eleonora

AU - Liu, Sen

AU - Mercuri, Luca

AU - Boxall, Naomi

AU - Jenner, Sarah

AU - Kendrick, Stuart

AU - Dong, Jane

AU - Theodore, Dickens

N1 - This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/.

PY - 2023/7/11

Y1 - 2023/7/11

N2 - Introduction: Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients’ demographic, clinical and biochemical characteristics across three continents and their associated treatment need. Methods: This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). Results: In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9–49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3–66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. Conclusion: This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.

AB - Introduction: Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients’ demographic, clinical and biochemical characteristics across three continents and their associated treatment need. Methods: This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). Results: In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9–49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3–66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. Conclusion: This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.

KW - Antiviral treatment

KW - Epidemiology

KW - Treatment status

KW - Undertreatment

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DO - 10.1007/s40121-023-00824-y

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SN - 2193-8229

VL - 12

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JO - Infectious Diseases and Therapy

JF - Infectious Diseases and Therapy

ER -

Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies

Abstract

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