Background/Purpose: 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. The aim of this study is to investigate the reactivity of HBV in rheumatoid arthritis patients treated with long-term low dose corticosteroids.

Methods: Patients with HBsAg positive who were diagnosed with rheumatoid arthritis and who received prednisolone of less than 10 mg/day over four weeks were selected at four university hospitals. Medical records and laboratory data were retrospectively analyzed and multivariate analysis was performed.

Results: One hundred forty five patients were included in the study and 26 (17.9%) patients were reactivated with HBV. Mean age was 50.7 years and 104 (71.7%) patients were female. Baseline characteristics including sex, age, past medical history and laboratory findings were not significantly different except the level of aspartate aminotransferase (21 vs. 83 IU/L, p <0.001) and alanine aminotransferase (23 vs. 104 IU/L, p <0.001) in patients with HBV reactivation compared to those without HBV reactivation. The administration of low-dose prednisolone did not affect HBV reactivation, and the duration of prednisolone administration, average daily prednisolone dose, and cumulative prednisolone dose did not affect the reactivation of HBV. However, the administration of leflunomide showed a significant difference in the reactivation of HBV (adjusted odds ratio 3.81; p=0.034), and the administration of hydroxychloroquine tended to cause reactivation of HBV (adjusted odds ratio 3.43; p=0.06).

Conclusion: 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, suggesting that it could be used safely. Further, prospective studies on the effect of conventional disease-modifying antirheumatic drugs such as leflunomide and hydroxychloroquine on the reactivation are needed.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-between-long-term-low-dose-steroid-administration-and-reactivation-of-hepatitis-b-virus-in-patients-with-rheumatoid-arthritis/