Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency.
adrenal insufficiency
corticosteroids
hepatitis B virus reactivation
rheumatic disease
Journal
Endocrinology, diabetes & metabolism
ISSN: 2398-9238
Titre abrégé: Endocrinol Diabetes Metab
Pays: England
ID NLM: 101732442
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
04
08
2018
revised:
16
04
2019
accepted:
24
04
2019
entrez:
12
7
2019
pubmed:
12
7
2019
medline:
12
7
2019
Statut:
epublish
Résumé
Whether or not reactivation of hepatitis B virus (HBV) might occur during corticosteroid therapy in hepatitis B surface antigen (HBsAg)-negative patients with adrenal insufficiency was investigated. We consecutively enrolled 66 patients with adrenal insufficiency undergoing physiological corticosteroid replacement therapy at Saitama Medical University Hospital between June 2013 and June 2014, and 220 patients with rheumatic disease receiving a pharmacologic dose of corticosteroids served as the positive control group. The latter group was separated into 101 patients treated only with corticosteroids, and 119 patients given corticosteroids plus immunosuppressants and/or disease-modifying antirheumatic drugs (DMARDs). HBsAg and antibody (Ab) levels against HBs, and hepatitis B core (HBc) were determined in all the patients. In patients with positive HBsAb and/or HBcAb, real-time PCR was performed for HBV-DNA. The incidence rates of conversion to HBV-DNA-positive status were evaluated. Hepatitis B virus reactivation occurred in six patients with rheumatic disease, three of whom were receiving a pharmacological dose of corticosteroids only, and three who were receiving corticosteroids with immunosuppressants and/or DMARDs. However, no reactivation occurred in patients receiving corticosteroid replacements for adrenal insufficiency. Maintenance and maximum corticosteroid doses administered to patients with rheumatic disease were significantly greater than those in patients with adrenal insufficiency. These results suggest that, although corticosteroid replacement therapy for adrenal insufficiency might be safe with respect to HBV reactivation, attention should be paid to HBV reactivation during corticosteroid therapy in rheumatic disease patients, since the dose of corticosteroids administered is usually large, and since other immunosuppressants are co-administered.
Identifiants
pubmed: 31294085
doi: 10.1002/edm2.71
pii: EDM271
pmc: PMC6613226
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e00071Commentaires et corrections
Type : ErratumIn
Déclaration de conflit d'intérêts
Nothing to declare.
Références
J Clin Oncol. 2009 Feb 1;27(4):605-11
pubmed: 19075267
Nat Med. 1996 Oct;2(10):1104-8
pubmed: 8837608
Clin Infect Dis. 2015 Sep 1;61(5):719-29
pubmed: 25935551
Cancer Res Treat. 2008 Mar;40(1):36-8
pubmed: 19688064
Mod Rheumatol. 2011 Feb;21(1):16-23
pubmed: 20668905
Ann Rheum Dis. 2017 Jun;76(6):1051-1056
pubmed: 27934678
Hepatology. 2014 Jun;59(6):2092-100
pubmed: 24002804
Eur J Haematol. 2001 Jul;67(1):45-50
pubmed: 11553266
Cancer. 2010 Jan 1;116(1):115-21
pubmed: 19899164
Clin Mol Hepatol. 2012 Jun;18(2):225-8
pubmed: 22893874
Hepatology. 2009 May;49(5 Suppl):S13-21
pubmed: 19399811
Ann Rheum Dis. 2002 Aug;61(8):718-22
pubmed: 12117678
Hepatology. 1992 Jul;16(1):13-8
pubmed: 1319949
N Engl J Med. 2001 Jan 4;344(1):68-9
pubmed: 11187122
Eur J Haematol. 2010 Sep;85(3):243-50
pubmed: 20491883
Gastroenterology. 2015 Jan;148(1):221-244.e3
pubmed: 25447852
Endocrinol Diabetes Metab. 2019 May 09;2(3):e00071
pubmed: 31294085
Gastroenterology. 1991 Jan;100(1):182-8
pubmed: 1983820
Gastroenterology. 2017 May;152(6):1297-1309
pubmed: 28219691
Gastroenterology. 2006 Jul;131(1):59-68
pubmed: 16831590