Impact of Nucleos(t)ide Analogs on Major Clinical Outcomes in Patients With Chronic Hepatitis B: A 10‐Year French Nationwide Cohort Study.

ABSTRACT Background Aims Methods Results Conclusions Conflicting results have been reported on the impact of tenofovir versus entecavir on liver‐related outcomes.To explore trends in clinical outcomes in chronic hepatitis B virus (HBV)–infected patients and compare the impact of tenofovir versus entecavir on the risk of hepatocellular carcinoma (HCC), liver transplantation (LT) and mortality.We used the French National Health Insurance Databases (SNDS) to identify HBV‐infected patients. We quantified the excess clinical burden from 2012 to 2021 by comparing the HBV‐infected cohort with a general population cohort, using 1:1 exact matching on birth date, sex, social deprivation index and follow‐up start date. The risks of mortality, HCC and LT were compared between patients treated with tenofovir and entecavir using inverse probability weighting.A total of 101,740 patients were matched to the general population. From 2012 to 2021, the average annual decreases in excess mortality, incidence of HCC and LT were 3.7%, 8.0% and 11.9%, respectively (p for trend < 0.001). During the same period, the nucleos(t)ide analog (NUC) treatment coverage significantly increased, particularly after 2016 (p < 0.001). Among 14,054 treatment‐naïve patients starting tenofovir (n = 7426) or entecavir (n = 6628), we observed no difference in the composite outcome of mortality, LT or HCC (HR, 1.09; 95% CI, 0.95–1.24). Tenofovir was associated with an increased risk of HCC compared with entecavir (HR, 1.31; 95% CI, 1.07–1.62).Tenofovir was associated with a higher risk of HCC compared with entecavir, although no difference in the composite outcome of mortality or liver‐related events was observed between the two treatments. [ABSTRACT FROM AUTHOR]