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

2018; Wiley; Volume: 39; Issue: 2 Linguagem: Inglês

10.1111/liv.13953

1478-3231

Grace Lai‐Hung Wong, Becky Wing‐Yan Yuen, Henry Lik‐Yuen Chan, Yee‐Kit Tse, Terry Cheuk‐Fung Yip, Kelvin Long‐Yan Lam, Grace Lui, Vincent Wai‐Sun Wong,

Hepatitis C virus research

Systemic corticosteroid is used for different medical conditions and may cause hepatitis B virus (HBV) reactivation.To study the impact of duration and peak dose of corticosteroid on the risk of hepatitis flare in patients with chronic hepatitis B (CHB).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 ( 40 mg) and durations ( 28 days). The primary endpoint was hepatitis flare (alanine aminotransferase >2×upper limit of normal, ie 80 IU/L) at 1 year.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 28 days (aHR 1.90 and 1.64 respectively, both P < 0.001).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.