AB0411 Risk of reactivation of hepatitis b virus in rheumatoid arthritis patients who received long-term low dose corticosteroid therapy
Authors: W. Jeong, J. Kim, E.-J. Park, B.-C. Song
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> It is well known that the use of corticosteroids results in increased viral replication and elevated ALT in patients with hepatitis B virus. The use of high dose corticosteroids for more than 4 weeks usually results in hepatitis worsening after cessation of steroids. However, few studies have investigated the effect of low dose corticosteroids on hepatitis B virus (HBV) reactivation. <h3>Objectives</h3> The aim of this study is to investigate the reactivity of HBV in rheumatoid arthritis (RA) patients treated with long term low dose corticosteroids and its risk factor. <h3>Methods</h3> Patients with HBsAg positive who were diagnosed with RA and who received prednisolone of less than 10 mg/day over four weeks and immunosuppressive agent were selected at four university hospitals in South Korea between June 1996 and March 2017. Medical records and laboratory data were retrospectively analysed and multivariate analysis was performed. <h3>Results</h3> One hundred forty five patients were included in the study and 26 (17.9%) patients were reactivated with HBV. Mean age at diagnosis of RA was 50.7 years and 41 (28.3%) patients were male. Baseline characteristics including sex, age and laboratory findings at diagnosis of rheumatoid arthritis were not significantly different in patients with HBV reactivation compared to those without HBV reactivation. The average daily dose of prednisolone was 3.65±2.77 mg and the mean duration of prednisolone was 5.11±5.05 years and the average cumulative dose of prednisolone was 5821.6±7021.3 mg. Eleven (42.3%) of 26 HBV reactivated patients were reactivated within one year after prednisolone administration and the period from the start of prednisolone administration to the reactivation was 4.08±5.77 years on average. The duration of prednisolone administration, mean daily dose of prednisolone, and cumulative prednisolone dose and administration of methotrexate, tacrolimus, tumour necrosis factor inhibitor and hydroxychloroquine did not significantly affect HBV reactivation in both univariate and multivariate analyses. However, the administration of leflunomide showed a significant difference in the reactivation of HBV (adjusted odd ratio 3.76; p=0.04) <h3>Conclusions</h3> The hepatitis B virus can be exacerbated by spontaneous viral reactivation, so it is difficult to conclude that hepatitis is caused by the administration of steroids. In this study, the administration of low-dose steroids did not affect the reactivation of HBV. However, leflunomide increased the risk of HBV reactivation when the effects of other disease modifying antirheumatic drug (DMARD) were corrected. Therefore, a prospective study is needed to evaluate the effect of DMARDs on HBV reactivation in the long – term administration of low – dose corticoststeroids in RA patients. <h3>References</h3> [1] Tur-Kaspa R, Burk RD, Shaul Y, et al. Hepatitis B virus DNA contains a glucocorticoid-responsive element. Proc Natl Acad Sci USA1986;83:1627–31. [2] Di Bisceglie AM, Lok AS, Martin P, et al. Recent US Food and Drug Administration warnings on hepatitis B reactivation with immune-suppressing and anticancer drugs: Just the tip of the iceberg?Hepatology2015;61:703–11. [3] Bae JH, Sohn JH, Lee HS, et al. A fatal case of hepatitis B virus (HBV) reactivation during long-term, very-low-dose steroid treatment in an inactive HBV carrier. Clin Mol Hepatol2012;18:225–8. <h3>Disclosure of Interest</h3> None declared