Treatment Discontinuation and Adherence in Patients With Chronic Hepatitis B Infection Newly Initiating Nucleos(t)ide Analogues in Japan: A Retrospective Cohort Study
Bibliographic record
Abstract
Nucleos(t)ide analogue (NA) therapy is the current standard of care for chronic hepatitis B (CHB) virus infection but rarely achieves functional cure, necessitating long-term therapy, which often leads to nonadherence and increased treatment burden. This retrospective cohort study was designed to describe treatment discontinuation and adherence to second-generation NAs among patients with CHB in Japan. We used the Japanese Medical Data Center Claims Database (JMDC Inc.) to identify adults with CHB who were newly initiated on a single-agent, second-generation NA between January 2007 and August 2023. Outcomes included treatment discontinuation and adherence, treatment restart after discontinuation, NA switching and factors associated with treatment discontinuation/adherence. Of the 2473 patients included in this study (mean age 49.9 years), 65.6% were male. The most common index NAs were entecavir (55.5%) and tenofovir alafenamide fumarate (TAF, 36.2%). Treatment discontinuation was observed in 20.3% of patients; mean time to discontinuation was 20.4 months. Of the patients who discontinued, 50.7% restarted NAs. Mean adherence (proportion of days covered [PDC]) was 0.87, and 81.2% of participants had PDC ≥ 80%. Age group 35-64 years, index treatment TAF and baseline hepatocellular carcinoma diagnosis were significantly associated with a decreased probability of treatment discontinuation and nonadherence. Although a high proportion of patients were persistent and adherent to NA treatment, there is a subgroup of patients whose needs are not met while receiving NA treatment, particularly in younger age groups. The results emphasise the need for alternative therapies with shorter, finite treatment durations to improve patient persistence, adherence and outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".