Risk of hepatitis B virus reactivation in patients with asthma or chronic obstructive pulmonary disease treated with corticosteroids.
OBJECTIVE
Reactivation of hepatitis B virus (HBV) is thought to be associated with immunosuppressive treatments, but insufficient information is available on the effect of corticosteroids. The aim of this study was to evaluate the risk of HBV reactivation in hepatitis B surface antigen-seropositive patients with asthma or COPD, who were treated with systemic corticosteroids (SCS) in addition to inhaled corticosteroids (ICS).


METHODS
Patients with asthma or COPD (n = 198), who were hepatitis B surface antigen-seropositive and had been treated with ICS, were identified retrospectively. To evaluate the additional effects of SCS, the SCS group was divided into those who received intermittent or continuous SCS (≥3 months of continuous SCS treatment), and into those who received low-dose (≤20 mg/day of prednisolone) or medium-to-high-dose SCS. The study outcome was HBV reactivation.


RESULTS
HBV reactivation occurred in 11.1% of patients in the SCS group, which was significantly higher than the reactivation rate in the ICS group. HBV reactivation was more frequent in the SCS group compared with the ICS group (OR 3.813, 95% CI: 1.106-13.145, P = 0.032), and in the continuous and medium-to-high-dose SCS subgroups compared with the ICS group (OR 5.719, 95% CI: 1.172-27.905, P = 0.048 and OR 4.884, 95% CI: 1.362-17.511, P = 0.014, respectively).


CONCLUSIONS
These results suggest that addition of SCS to ICS increases the risk of HBV reactivation, especially when SCS are administered chronically or at high doses.
Kim
Tae-Wan
TW
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Kim
Mi-Na
MN
Kwon
Jae-Woo
JW
Kim
Kyung-Mook
KM
Kim
Sae-Hoon
SH
Kim
Won
W
Park
Heung-Woo
HW
Chang
Yoon-Seok
YS
Cho
Sang-Heon
SH
Min
Kyung-Up
KU
Kim
You-Young
YY
D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006509:Hepatitis B / Q000139:chemically induced*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*
D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D006514:Hepatitis B Surface Antigens; D011239:Prednisolone