In rheumatology patients with hepatitis B, a 7-day regimen of corticosteroids was safe, according to a study of 23 patients.
“Reactivation of [hepatitis B virus] HBV infection triggered by immunosuppression withdrawal had been described mainly in patients receiving chemotherapy or rituximab along with corticosteroids, for hematologic or other malignancies, but this was not the case in our study,” Yolanda Braun-Moscovici, MD, in the rheumatology unity at the Technion-Israeli Institute of Technology, and colleagues wrote. “No reactivation was observed in patients receiving only the short-term courses of corticosteroids.”
To assess whether short-term corticosteroids induce HBV reactivation, Moscovici and colleagues assessed the records of all rheumatology patients treated with corticosteroids between 2001 and 2014 who tested positive for only hepatitis B surface antigen (HBsAg) or who tested positive for hepatitis B core antigen (HBcore) antibodies and negative for anti-HBsAg antibodies. The researchers recorded alanine aminotransferase (ALT) levels, HBV serology, and serum HBV DNA at baseline and between 1 month and 3 months after discharge.
The investigators found data for 23 patients who were hospitalized a total of 73 times and received 7 days of treatment with intravenous corticosteroids. Eighteen patients were positive for HBsAg. The investigators noted the mean methylprednisolone dose was 33.9 mg per day. Concomitant therapy included conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs and low-dose corticosteroids. The researchers detected serum HBV DNA at baseline in seven patients. Three patients who were HBsAg-positive and who were treated with cyclophosphamide had HBV flare-ups and elevated ALT.
Two patients who were positive for HBsAg had a reappearance of HBV DNA in their serum after treatment with azathioprine and infliximab, despite normal ALT levels. In all patients, lamivudine reduced serum HBV DNA and improved ALT levels. Corticosteroid therapy alone did not exacerbate HBV. In addition, no HBV reactivation occurred in patients treated with lamivudine after recurrent exposure to biologics or cyclophosphamide.
The researchers concluded a 7-day regimen of corticosteroids seemed safe in patients with HBV, even in the presence of csDMARDs. However, lamivudine should be considered in patients exposed to biologics or cyclophasmide.
“The intriguing data that no flare-ups were observed due to corticosteroids is reassuring and should encourage the performance of randomized controlled trials to determine the safety of short-term moderate-dose corticosteroid courses in HBV-positive patients and the necessity of prophylaxis,” the researchers wrote. “The conclusions may be relevant for a wide range of patients with rheumatologic, allergic and pulmonary conditions.” – by Will Offit
Reference: The researchers report no relevant financial disclosures.