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


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 (<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.

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).

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.
著者Wong GLH, Yuen BWY, Chan HLY, Tse YK, Yip TCF, Lam KLY, Lui GCY, Wong VWS
期刊名稱Liver International
頁次271 - 279
關鍵詞antiviral treatment, chronic hepatitis B, corticosteroid, hepatitis flare, icteric flare, immunosuppressants, immunosuppressive therapy
Web of Science 學科類別Gastroenterology & Hepatology;Gastroenterology & Hepatology

上次更新時間 2020-15-08 於 02:59