NEW YORK (Reuters Health) – In people with resolved hepatitis B virus (HBV) infection, exposure to higher doses of corticosteroids is associated with an increased risk of HBV reactivation and hepatitis flare, according to researchers in China.
“This study proposed a time-weighted average dose of prednisone to quantify corticosteroid exposure, and this indicator, instead of cumulative dose, positively predicted the risk of HBV reactivation or hepatitis flare in patients with resolved HBV infection,” the team writes in Annals of Rheumatic Diseases.
In the single-site study, Dr. Peizeng Yang of the First Affiliated Hospital of Chongqing Medical University and his colleagues enrolled 1,300 consecutive uveitis patients with negative hepatitis B surface antigen positive anti-hepatitis B core status whether or not they were receiving systemic corticosteroids.
The researchers continuously monitored corticosteroid medication and HBV reactivation in patients with resolved HBV infection with uveitis. They determined corticosteroid exposure by calculating cumulative dose and time-weighted average daily dose of prednisone. The primary outcome was the time to a composite of HBV reactivation, hepatitis flare, or severe hepatitis.
Among all study participants, the median of cumulative dose of prednisone was 3,000 mg, and the time-weighted average dose of the drug was 15 mg/day.
In multivariable analyses, cumulative dose showed an inverted V-shaped relationship with risk of a composite of HBV reactivation, hepatitis flare or severe hepatitis; this risk peaked (HR, 3.72) at a cumulative dose of 1,506 mg.
Quartiles of time-weighted average dose were independently and significantly linked with increased event risk (HR per quartile increase, 2.15; HR, 49.48 in top quartile). In the top quartile of time-weighted average dose – more than 20 mg/day – the primary outcome incidence rate was 16.67 per 100 person-years. Prednisone use with a time-weighted average dose greater than 20 mg/day resulted in an incidence of HBV reactivation or hepatitis flare of more than 10 per 100 person-years in patients with resolved HBV infection.
“Prophylactic Anti-HBV therapy may therefore be needed for these high-risk patients,” the authors write. “Guidelines are currently in consensus on recommending the use of anti-hepatitis B virus (HBV) prophylaxis in patients with positive hepatitis B surface antigen (HBsAg) before corticosteroid therapy, but such a consensus has not been reached in the management of patients with resolved HBV infection with an HBsAg-negative Anti-hepatitis B core positive status,” they explain. “Due to the lack of systemically collected data, reliable risk assessment and stratification of HBV reactivation in corticosteroid users with resolved HBV infection are lacking.”
“Assessment of time-weighted average prednisone dose, instead of the peak dose, treatment duration and cumulative dose, would allow for the risk stratification for HBV reactivation in patients with resolved HBV infection treated with corticosteroids for a variety of rheumatic diseases,” they write.
The study did not receive commercial funding, and the authors report no conflicts of interest.
Dr. Yang was not able to comment on the study by press time.
SOURCE: https://bit.ly/3AdnkkG Annals of Rheumatic Diseases, online December 21, 2021.
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