Impact of dose and duration of corticosteroid on the risk of hepatitis flare in patients with chronic hepatitis B
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
Liver international : official journal of the International Association for the Study of the Liver - 39(2019), 2 vom: 09. Feb., Seite 271-279 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wong, Grace Lai-Hung [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 13.02.2020 Date Revised 13.02.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/liv.13953 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM288169778 |
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| 041 | |a eng | ||
| 100 | 1 | |a Wong, Grace Lai-Hung |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of dose and duration of corticosteroid on the risk of hepatitis flare in patients with chronic hepatitis B |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 13.02.2020 | ||
| 500 | |a Date Revised 13.02.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Systemic corticosteroid is used for different medical conditions and may cause hepatitis B virus (HBV) reactivation | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a antiviral treatment | |
| 650 | 4 | |a chronic hepatitis B | |
| 650 | 4 | |a corticosteroid | |
| 650 | 4 | |a hepatitis flare | |
| 650 | 4 | |a icteric flare | |
| 650 | 4 | |a immunosuppressants | |
| 650 | 4 | |a immunosuppressive therapy | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 650 | 7 | |a DNA, Viral |2 NLM | |
| 700 | 1 | |a Yuen, Becky Wing-Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Henry Lik-Yuen |e verfasserin |4 aut | |
| 700 | 1 | |a Tse, Yee-Kit |e verfasserin |4 aut | |
| 700 | 1 | |a Yip, Terry Cheuk-Fung |e verfasserin |4 aut | |
| 700 | 1 | |a Lam, Kelvin Long-Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Lui, Grace Chung-Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Vincent Wai-Sun |e verfasserin |4 aut | |
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