Prophylactic antiviral therapy and all-cause mortality in cancer patients with hepatitis B e antigen-negative chronic hepatitis B virus infection receiving immunosuppressive therapy

Abstract Background The survival benefits of prophylactic antiviral therapy for cancer patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection who require immunosuppressive therapy (IST) remain unclear. The present study aims to evaluate the association of prophylactic antiviral therapy with all-cause and cause-specific mortality in cancer patients. Methods This multicenter, retrospective cohort study included cancer patients with HBeAg-negative chronic HBV infection who received IST between January 2012 and December 2022. Patients were divided into groups with or without prophylactic antiviral therapy with nucleos(t)ide analogues. The primary outcome was all-cause mortality within 1 year and secondary outcomes included cancer-related mortality, liver-related mortality, and hepatitis B virus reactivation (HBVr). Confounding factors in patients who did and did not receive antiviral prophylaxis were balanced by propensity score overlap weighting. The associations between prophylactic antiviral therapy and outcomes were assessed by Cox proportional hazards models. Results Of the 3677 cancer patients deemed eligible for inclusion, 1541 (41.9%) initiated antiviral prophylaxis and 2136 (58.1%) did not. After overlap weighting, prophylactic antiviral therapy was significantly associated with lower risks of all-cause mortality (hazard ratio [HR] = 0.82; 95% CI = 0.70 to 0.96), cancer-related mortality (HR = 0.82; 95% CI = 0.69 to 0.97), and HBVr (HR = 0.49; 95% CI = 0.39 to 0.61) within 1 year. Consistent results were found across various subgroups and multiple sensitivity analyses. Conclusions Initiation of prophylactic antiviral therapy was associated with significant reductions in mortality and HBVr within 1 year in cancer patients with HBeAg-negative chronic HBV infection who received IST in real-world clinical practice.