Invited Editorials
Editorial: metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B – authors’ reply J. Hsiang*,†, G. L.-H. Wong*,†,‡, H. L.-Y. Chan*,†,‡ & V. W.-S. Wong*,†,‡ *Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. † Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. ‡ State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. E-mail: [email protected] doi:10.1111/apt.12932
We thank Drs Danta and Bradshaw for their comments.1 They pointed out the relevance of the interaction between metabolic syndrome and chronic hepatitis B (CHB), given the prevalence of the two diseases and the confounding effect of the age of patients. Our study of 413 hepatitis B e antigen (HBeAg)-positive, treatment-na€ıve patients were split into three groups of varying metabolic risks.2 The patients with metabolic risk factors (pre-MetS and MetS groups), despite being older compared with the normal group, had comparable baseline viral load, alanine aminotransferase level and genotype distribution which are all critical factors associated with delayed HBeAg seroconversion. To tackle the confounding effect of age, we chose age at HBeAg seroclearance as the time variable in the Cox regression analysis. This would avoid any younger patients entering the study with a longer follow-up without HBeAg seroclea-
Editorial: can we afford the new direct-acting antivirals for treatment of genotype 1 hepatitis C? S. E. Congly & S. S. Lee Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, Canada. E-mail: [email protected] doi:10.1111/apt.12927
Saab et al.1 report their cost-effectiveness analysis of treatment of hepatitis C virus (HCV) genotype 1 infecAliment Pharmacol Ther 2014; 40: 982-989 ª 2014 John Wiley & Sons Ltd
rance being censored and an older patient with HBeAg seroclearance within a short follow-up. We agree with the need to control key variables such as age and gender to tease out the specific interaction between obesity-related features and chronic hepatitis B. This would involve an age and gender-matched cohort with younger age patients and longer follow-up. The low prevalence of hepatitis B infection in the era of hepatitis B vaccine would make such studies difficult, and the prevalence of metabolic syndrome in younger patients would be low. Further studies should also investigate the effect of adipokines on viral clearance and validate the study findings in other populations.3, 4
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Danta M, Bradshaw D. Editorial: metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B. Aliment Pharmacol Ther 2014; 40: 982. 2. Hsiang JC, Wong GL-H, Chan HL-Y, Chan AW-H, Chim AM-L, Wong VW-H. Metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B. Aliment Pharmacol Ther 2014; 40: 716–26. 3. Chiang CH, Lai JS, Hung SH, Lee LT, Sheu JC, Huang KC. Serum adiponectin levels are associated with hepatitis B viral load in overweight to obese hepatitis B virus carriers. Obesity (Silver Spring) 2013; 21: 291–6. 4. Wong VW, Wong GL, Yu J, et al. Interaction of adipokines and hepatitis B virus on histological liver injury in the Chinese. Am J Gastroenterol 2010; 105: 132–8.
tions with sofosbuvir and peginterferon plus ribavirin (IFN/RBV) as compared with all currently commercially available treatments including simeprevir and IFN/RBV. Through Markov modelling, outcomes in treatment-na€ıve, treatment-experienced and HCV/HIV co-infected populations were evaluated based on a US third-party payer perspective. Sofosbuvir-based arms were the most efficacious overall, and economically dominated (i.e. were less expensive and more effective) telaprevir- and boceprevir-based strategies in all subgroups. Sofosbuvir dominated simeprevir except in cirrhosis where simeprevir had a very favourable incremental cost-effectiveness ratio ($1899 per QALY gained). 983
Editorial: metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B – authors’ reply J. Hsiang*,†, G. L.-H. Wong*,†,‡, H. L.-Y. Chan*,†,‡ & V. W.-S. Wong*,†,‡ *Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. † Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. ‡ State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. E-mail: [email protected] doi:10.1111/apt.12932
We thank Drs Danta and Bradshaw for their comments.1 They pointed out the relevance of the interaction between metabolic syndrome and chronic hepatitis B (CHB), given the prevalence of the two diseases and the confounding effect of the age of patients. Our study of 413 hepatitis B e antigen (HBeAg)-positive, treatment-na€ıve patients were split into three groups of varying metabolic risks.2 The patients with metabolic risk factors (pre-MetS and MetS groups), despite being older compared with the normal group, had comparable baseline viral load, alanine aminotransferase level and genotype distribution which are all critical factors associated with delayed HBeAg seroconversion. To tackle the confounding effect of age, we chose age at HBeAg seroclearance as the time variable in the Cox regression analysis. This would avoid any younger patients entering the study with a longer follow-up without HBeAg seroclea-
Editorial: can we afford the new direct-acting antivirals for treatment of genotype 1 hepatitis C? S. E. Congly & S. S. Lee Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, Canada. E-mail: [email protected] doi:10.1111/apt.12927
Saab et al.1 report their cost-effectiveness analysis of treatment of hepatitis C virus (HCV) genotype 1 infecAliment Pharmacol Ther 2014; 40: 982-989 ª 2014 John Wiley & Sons Ltd
rance being censored and an older patient with HBeAg seroclearance within a short follow-up. We agree with the need to control key variables such as age and gender to tease out the specific interaction between obesity-related features and chronic hepatitis B. This would involve an age and gender-matched cohort with younger age patients and longer follow-up. The low prevalence of hepatitis B infection in the era of hepatitis B vaccine would make such studies difficult, and the prevalence of metabolic syndrome in younger patients would be low. Further studies should also investigate the effect of adipokines on viral clearance and validate the study findings in other populations.3, 4
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Danta M, Bradshaw D. Editorial: metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B. Aliment Pharmacol Ther 2014; 40: 982. 2. Hsiang JC, Wong GL-H, Chan HL-Y, Chan AW-H, Chim AM-L, Wong VW-H. Metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B. Aliment Pharmacol Ther 2014; 40: 716–26. 3. Chiang CH, Lai JS, Hung SH, Lee LT, Sheu JC, Huang KC. Serum adiponectin levels are associated with hepatitis B viral load in overweight to obese hepatitis B virus carriers. Obesity (Silver Spring) 2013; 21: 291–6. 4. Wong VW, Wong GL, Yu J, et al. Interaction of adipokines and hepatitis B virus on histological liver injury in the Chinese. Am J Gastroenterol 2010; 105: 132–8.
tions with sofosbuvir and peginterferon plus ribavirin (IFN/RBV) as compared with all currently commercially available treatments including simeprevir and IFN/RBV. Through Markov modelling, outcomes in treatment-na€ıve, treatment-experienced and HCV/HIV co-infected populations were evaluated based on a US third-party payer perspective. Sofosbuvir-based arms were the most efficacious overall, and economically dominated (i.e. were less expensive and more effective) telaprevir- and boceprevir-based strategies in all subgroups. Sofosbuvir dominated simeprevir except in cirrhosis where simeprevir had a very favourable incremental cost-effectiveness ratio ($1899 per QALY gained). 983
