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    Home > Active Ingredient News > Infection > ARD: Mean glucocorticoid dose and risk of HBV reactivation and hepatitis flare in patients with remission of hepatitis B infection

    ARD: Mean glucocorticoid dose and risk of HBV reactivation and hepatitis flare in patients with remission of hepatitis B infection

    • Last Update: 2022-01-23
    • Source: Internet
    • Author: User
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         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 .


         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 .


         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
    .

         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
    .

         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 .

         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 .

         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
    .
     

         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
    .
     

    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

    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
    , et al Annals of the Rheumatic Diseases 

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