OBJECTIVE: Glucocorticoids (corticosteroids) remain the mainstay of treatment for rheumatic diseases, but lead to reactivation of hepatitis B virus (HBV) in patients with remission of HBV infection .
Risk assessment and stratification are needed to guide the management of these patients prior to corticosteroid therapy .
Risk assessment and stratification are needed to guide the management of these patients prior to corticosteroid therapy .
Methods: A research team from the First Affiliated Hospital of Chongqing Medical University prospectively recruited patients with HBsAg-positive anti-hepatitis B core status with or without corticosteroids and calculated cumulative doses of prednisone and time-weighted average daily dose to determine corticosteroid exposure
.
The primary outcome was the composite time of HBV reactivation, hepatitis flare, or severe hepatitis
.
.
The primary outcome was the composite time of HBV reactivation, hepatitis flare, or severe hepatitis
.
RESULTS: Among 1303 participants, the median cumulative and time-weighted mean doses of prednisone used in this cohort were 3000 mg ( IQR : 300-6750 mg ) and 15 mg/ day ( IQR : 10-20 , respectively) mg/ day)
.
In multivariate analysis, cumulative dose had an inverted V -shaped relationship with primary events, with a peak at cumulative dose of 1506 mg ( HR : 3.
72 ; 95% CI , 1.
96-7.
08 )
.
Interquartiles of time-weighted mean dose were independently associated with monotonic increases in event risk ( HR for each quartile increase : 2.
15 ; 95% CI , 1.
56-2.
98 ), 75%-100% HR for the highest quartile reached 49.
48 ( 95% CI, 6.
24-392.
48 )
.
In the highest quartile of time-weighted mean dose ( Q4>20 mg/ day), the incidence of the primary outcome was 16.
67/100 person-years
.
The incidence of the primary outcome in the other quartiles was all less than 10 per 100 person-years .
.
In multivariate analysis, cumulative dose had an inverted V -shaped relationship with primary events, with a peak at cumulative dose of 1506 mg ( HR : 3.
72 ; 95% CI , 1.
96-7.
08 )
.
Interquartiles of time-weighted mean dose were independently associated with monotonic increases in event risk ( HR for each quartile increase : 2.
15 ; 95% CI , 1.
56-2.
98 ), 75%-100% HR for the highest quartile reached 49.
48 ( 95% CI, 6.
24-392.
48 )
.
In the highest quartile of time-weighted mean dose ( Q4>20 mg/ day), the incidence of the primary outcome was 16.
67/100 person-years
.
The incidence of the primary outcome in the other quartiles was all less than 10 per 100 person-years .
Conclusions: Patients with a time-weighted mean prednisone dose greater than 20 mg/day would be classified as a high-risk group for HBV reactivation or hepatitis recurrence
.
These high-risk patients may require prophylactic anti- HBV therapy
.
.
These high-risk patients may require prophylactic anti- HBV therapy
.
Source:
Source:Zhong Z, Liao W, Dai L , et al .
Average corticosteroid dose and risk for HBV reactivation and hepatitis flare in patients with resolved hepatitis B infection.
Annals of the Rheumatic Diseases Published Online First: 21 December 2021.
doi: 10.
1136/annrheumdis- 2021-221650
Average corticosteroid dose and risk for HBV reactivation and hepatitis flare in patients with resolved hepatitis B infection.
Annals of the Rheumatic Diseases Published Online First: 21 December 2021.
doi: 10.
1136/annrheumdis- 2021-221650 , et al Annals of the Rheumatic Diseases
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