Chronic hepatitis D associated with worse patient-reported outcomes than chronic hepatitis B

Maria Buti; Maria Stepanova; Adriana Palom; Mar Riveiro-Barciela; Fatema Nader; Luisa Roade; Rafael Esteban; Zobair Younossi

doi:10.1016/j.jhepr.2021.100280

Chronic hepatitis D associated with worse patient-reported outcomes than chronic hepatitis B

JHEP Rep. 2021 Mar 17;3(3):100280. doi: 10.1016/j.jhepr.2021.100280. eCollection 2021 Jun.

Authors

Maria Buti^{1

2}, Maria Stepanova³, Adriana Palom¹, Mar Riveiro-Barciela^{1

2}, Fatema Nader³, Luisa Roade^{1

2}, Rafael Esteban^{1

2}, Zobair Younossi^{4

5}

Affiliations

¹ Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus and Universitat Autònoma de Barcelona, Barcelona, Spain.
² Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
³ Center for Outcomes Research in Liver Disease, Washington, DC, USA.
⁴ Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
⁵ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.

Abstract

Background & aims: Health-related quality of life (HRQoL) determined by patient-reported outcomes (PROs) is impaired in chronic hepatitis B (CHB) and C patients, but there are no data regarding patients with chronic hepatitis D (CHD). The aim of this study was to assess PRO scores in untreated patients with CHD and compare them with those obtained for patients with CHB.

Methods: Patients with CHD completed 3 PRO instruments (Chronic Liver Disease Questionnaire [CLDQ], Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F], and Work Productivity and Activity Impairment [WPAI]), and the results were compared with those of patients mono-infected with CHB.

Results: In total, 125 patients were included: 43 with CHD and 82 with CHB. Overall, baseline PROs showed differences between both groups. Several assessments, such as the worry score from CLDQ (p = 0.0118), functional well-being from FACIT-F (p = 0.0281), and activity impairment from WPAI (p = 0.0029) showed a significant trend to worse scores in patients with CHD than with CHB. In addition, the linear regression model supports the finding that having CHD as opposed to having CHB was a predictor of a higher worry score (CLDQ) and a higher activity impairment (WPAI).

Conclusions: In this first assessment in CHD, PROs recorded in patients with CHD showed a significant impairment in some domains of HRQoL questionnaires in comparison with those with CHB. Studies in larger cohorts with lengthier follow-up are needed to fully assess patient-reported quality of life over the course of CHD.

Lay summary: Chronic hepatitis D (CHD) is a viral disease that causes rapid evolution to liver cirrhosis, amongst other severe complications, when compared to patients with chronic hepatitis B (CHB). Health-related quality of life in chronic hepatitis C and CHB has been reported widely, but no studies have been performed on patient-reported outcomes in patients with CHD. Results showed that CHD patients reported worse outcomes in psychological domains such as worry and emotional well-being, as well as in physical domains such as abdominal symptoms, physical well-being, and activity impairment in comparison with patients with CHB.

Keywords: ALT, alanine aminotransferase; APRI, AST to platelet ratio index; AST, aspartate aminotransferase; CHB, chronic hepatitis B; CHC, chronic hepatitis C; CHD, chronic hepatitis D; CLDQ, Chronic Liver Disease Questionnaire; Chronic Liver Disease Questionnaire; DAA, direct-acting antivirals; EMA, European medicines agency; FACIT-F, Functional Assessment of Chronic Illness Therapy–Fatigue; FIB-4, Fibrosis-4; Functional Assessment of Chronic Illness Therapy–Fatigue; HRQoL, health-related quality of life; Health-related quality of life; IFN, interferon; LLOD, lower limit of detection; LLOQ, lower limit of quantification; NAs, nucleos(t)ide analogues; PROs, patient-reported outcomes; Viral hepatitis; WPAI, Work Productivity and Activity Impairment; Work Productivity Activity Impairment; pegIFN, pegylated interferon.