Impact of dose and duration of corticosteroid on the risk of hepatitis flare in patients with chronic hepatitis B

• Published in: Liver international Vol. 39; no. 2; pp. 271 - 279
• Main Authors: Wong, Grace Lai‐Hung, Yuen, Becky Wing‐Yan, Chan, Henry Lik‐Yuen, Tse, Yee‐Kit, Yip, Terry Cheuk‐Fung, Lam, Kelvin Long‐Yan, Lui, Grace Chung‐Yan, Wong, Vincent Wai‐Sun, Negro, Francesco
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2019
• Subjects: Activation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adult; Aged; Alanine; Alanine transaminase; Antiviral Agents - therapeutic use; antiviral treatment; chronic hepatitis B; corticosteroid; Corticosteroids; DNA, Viral - blood; Dose-Response Relationship, Drug; Equivalence; Female; Health risk assessment; Hepatitis; Hepatitis B; Hepatitis B, Chronic - drug therapy; hepatitis flare; Hong Kong; Humans; icteric flare; immunosuppressants; immunosuppressive therapy; Interferon; Kaplan-Meier Estimate; Male; Middle Aged; Patients; Prednisolone; Prophylaxis; Proportional Hazards Models; Rank tests; Recurrence; Retrospective Studies; Risk analysis; Risk factors; Viruses; Hong Kong; chronic hepatitis B; immunosuppressive therapy; antiviral treatment; hepatitis flare; immunosuppressants; corticosteroid; icteric flare
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13953

Background Systemic corticosteroid is used for different medical conditions and may cause hepatitis B virus (HBV) reactivation. Aims To study the impact of duration and peak dose of corticosteroid on the risk of hepatitis flare in patients with chronic hepatitis B (CHB). Methods All patients who received corticosteroid from January 2001 to December 2004 were retrieved from the Hospital Authority, Hong Kong. We stratified patients by daily dose prednisolone equivalents (<20 mg, 20‐40 mg, >40 mg) and durations (<7; 7‐28; >28 days). The primary endpoint was hepatitis flare (alanine aminotransferase >2×upper limit of normal, ie 80 IU/L) at 1 year. Results A total of 85 763 patients fulfilled the inclusion criteria (5254 CHB, 80 509 non‐CHB). CHB patients had higher risk of hepatitis flare (388/5254 [7.8%]) than those without CHB (2728/80 509 [4.2%]; P < 0.001 by log‐rank test). Among CHB patients, peak daily dose >40 mg compared to <20 mg prednisolone equivalents (adjusted hazard ratio [aHR] 1.64, 95% CI 1.26‐2.14; P < 0.001) was an independent risk factor of hepatitis flare. Risk of hepatitis flare started to increase in those receiving corticosteroid of peak daily dose >40 mg prednisolone equivalents even for <7 days (aHR 1.55, P = 0.026), which was also increased for 7‐28 days and >28 days (aHR 1.90 and 1.64 respectively, both P < 0.001). Conclusion Even short courses of high‐dose corticosteroid increase the risk of hepatitis flare in CHB patients. Patients receiving high‐dose corticosteroid should be considered for antiviral prophylaxis regardless of the duration of treatment.