Inhaled plus systemic steroid treatment linked to HBV reactivation
MedWire News: Results from a South Korean study suggest that the addition of systemic corticosteroids (SCSs) to inhaled corticosteroid (ICS) treatment in patients with asthma or chronic obstructive pulmonary disease (COPD) is associated with an increased risk for hepatitis B virus (HBV) reactivation.
Heung-Woo Park (Seoul National University College of Medicine) and colleagues explain: "Reactivation of HBV is thought to be associated with immunosuppressive treatments."
To investigate this in patients with asthma or COPD, the team studied data on 198 Korean patients who were initially carriers of inactive HBV and were treated at Seoul National University Bundang Hospital between 1997 and 2007.
The prevalence of hepatitis B surface antigen (HBsAg) seropositivity is high in the South Korean population, affecting around 5.1% of men and 4.1% of women, the researchers note.
In total, 126 patients were assigned to take ICSs alone and 72 were assigned to take ICSs and SCSs. Patients in the SCS group were divided into those who received intermittent or continuous (for at least 3 months) SCS treatment, and into those who received low- or medium-to-high-dose SCSs.
HBV reactivation occurred in a total of 12 (6.1%) patients during the study period. Of these patients, four (3.2% of 126) were taking ICSs alone and eight (11.1% of 72) were taking ICSs plus SCS - a significant difference, at an odds ratio (OR) of 3.8.
The risk for HBV reactivation was even higher among patients in the continuous and medium-to-high-dose SCS subgroups, at ORs of 5.7 and 4.9 [rounded up] compared with patients taking ICS alone.
Park and team conclude: "The present findings suggest that addition of SCSs to ICS treatment increased the risk of HBV reactivation, especially when SCSs were administered chronically or at relatively higher doses.
"Therefore, screening for HBV reactivation should be considered for patients receiving chronic or high-dose SCS treatment. Furthermore, prophylactic antiviral treatment should be considered for patients with severe asthma or COPD who require high-dose or long-term SCS treatment, especially during intermittent exacerbations that require higher doses of SCSs, and when screening for HBV reactivation is not available."
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By Mark Cowen