4.7 Article

Average corticosteroid dose and risk for HBV reactivation and hepatitis flare in patients with resolved hepatitis B infection

期刊

ANNALS OF THE RHEUMATIC DISEASES
卷 81, 期 4, 页码 584-591

出版社

BMJ PUBLISHING GROUP
DOI: 10.1136/annrheumdis-2021-221650

关键词

corticosteroids; autoimmune diseases; immune system diseases; inflammation; glucocorticoids

资金

  1. National Natural Science Foundation Key Program [81930023]
  2. Natural Science Foundation Major International (Regional) Joint Research Project [81720108009]
  3. Chongqing Key Laboratory of Ophthalmology [2008CA5003]
  4. Chongqing Outstanding Scientists Project (2019)
  5. Chongqing Chief Medical Scientist Project (2018)
  6. Chongqing Science and Technology Platform and Base Construction Program [cstc2014pt-sy10002]

向作者/读者索取更多资源

Patients with a time-weighted average prednisone dose greater than 20 mg/day may be classified as high risk for HBV reactivation or hepatitis flare, and prophylactic anti-HBV therapy may be needed for these high-risk patients.
Objectives Corticosteroids remain the mainstay of treatment for rheumatic diseases but can cause hepatitis B virus (HBV) reactivation in patients with resolved HBV infection. Risk assessment and stratification are needed to guide the management of these patients before corticosteroid therapy. Methods We prospectively enrolled patients with negative hepatitis B surface antigen positive Anti-hepatitis B core status with or without corticosteroid use and 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. Results Among 1303 participants, the median of cumulative dose and time-weighted average dose of prednisone used in this cohort was 3000 mg (IQR: 300-6750 mg) and 15 mg/day (IQR: 10-20 mg/day), respectively. In multivariable analyses, cumulative dose showed inverted V-shaped relationship with primary events, which peaked at a cumulative dose of 1506 mg (HR: 3.72; 95% CI, 1.96 to 7.08). Quartiles of time-weighted average dose were independently associated with a monotonic increase in event risk (HR per quartile increase: 2.15; 95% CI, 1.56 to 2.98), reaching an HR of 49.48 (95% CI, 6.24 to 392.48) in the top quartile. The incidence of primary outcome was 16.67 per 100 person-years in the top quartile of time-weighted average dose (Q4>20 mg/day). Other quartiles all had an incidence of primary outcome less than 10 per 100 person-years. Conclusion Patients with time-weighted average prednisone dose greater than 20 mg/day would be classified as the high risk for HBV reactivation or hepatitis flare. Prophylactic Anti-HBV therapy may be needed for these high-risk patients.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.7
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据