Zhong Zhenyu, Liao Weiting, Dai Lingyu, Feng Xiaojie, Su Guannan, Gao Yu, Wu Qiuying, Yang Peizeng
The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China.
The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
Ann Rheum Dis. 2022 Apr;81(4):584-591. doi: 10.1136/annrheumdis-2021-221650. Epub 2021 Dec 21.
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.
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.
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.
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.
ChiCTR1900023955.
糖皮质激素仍然是治疗风湿性疾病的主要药物，但可导致乙肝病毒（HBV）感染已缓解的患者出现HBV再激活。在糖皮质激素治疗前，需要进行风险评估和分层以指导这些患者的管理。
我们前瞻性纳入乙肝表面抗原阴性、乙肝核心抗体阳性且使用或未使用糖皮质激素的患者，并通过计算泼尼松的累积剂量和时间加权平均每日剂量来确定糖皮质激素暴露情况。主要结局是出现HBV再激活、肝炎发作或严重肝炎这一复合情况的时间。
在1303名参与者中，该队列中使用的泼尼松累积剂量中位数为3000mg（四分位间距：300 - 6750mg），时间加权平均剂量为15mg/天（四分位间距：10 - 20mg/天）。在多变量分析中，累积剂量与主要事件呈倒V形关系，在累积剂量为1506mg时达到峰值（风险比：3.72；95%置信区间，1.96至7.08）。时间加权平均剂量的四分位数与事件风险的单调增加独立相关（每增加一个四分位数的风险比：2.15；95%置信区间，1.56至2.98），在最高四分位数时风险比达到49.48（95%置信区间，6.24至392.48）。时间加权平均剂量最高四分位数（Q4>20mg/天）时主要结局的发生率为每100人年16.67例。其他四分位数的主要结局发生率均低于每100人年10例。
时间加权平均泼尼松剂量大于20mg/天的患者可被归类为HBV再激活或肝炎发作的高风险患者。这些高风险患者可能需要预防性抗HBV治疗。
ChiCTR1900023955。
