IBD Patients Exposed to Steroids at an Increased Risk of Hepatitis B Flares

Joyce Wing Yan Mak

Biologics do not lead to an increased risk of hepatitis B virus (HBV) flares when compared to steroids and thiopurines for inflammatory bowel disease (IBD) patients.

A team, led by Joyce Wing Yan Mak, the Chinese University of Hong Kong-Prince of Wales Hospital, Department of Medicine and Therapeutics, examined the risk of hepatitis flare in IBD patients with previous HBV exposure.

The data was presented during the 16th Congress of European Crohn's and Colitis Organisation (ECCO).

IBD Drugs

Biological therapies, thiopurines, and steroids are common treatments for IBD. However, these classes of therapeutics could cause hepatitis B virus reactivation. However, the exact risk of HBV flares in patients with previous hepatitis B virus exposure is not well defined.

The researchers identified patients from a territory-wide Hong Kong IBD Registry and included patients who were negative for HBsAg and received biological therapies or thiopurines or steroids between January 2000 and June 2019.

Exposure

Patients with previous HBV exposure included individuals who were positive for total antibody to hepatitis B core antigen (anti-HBc) and/or hepatitis B surface antigen (anti-HBs).

The investigators sought a primary endpoint of the development of hepatitis flare (alanine Aminotransferase [ALT) >80 U/L).

There was 369 participants in the study who fulfilled the inclusion criteria. The researchers split the patients in 3 separate groups—anti-HBs positive only (n = 246); anti-HBs and anti-HBc positive (n = 78) and anti-HBc positive only (n = 45). The median follow-up duration was 60 months.

In addition, 20.6% (n = 76) of IBD patients developed hepatitis flare and the cumulative incidence of hepatitis flare were 13.2%, 18.3%, and 22% at 12 months, 36 months, and 60 months, respectively.

Results Based on Treatment Type

The use of thiopurine (aHR, 2.56; 95% CI, 1.54-4.26; P <0.001) and ever being exposed to steroids (aHR, 2.73; 95% CI, 1.30-5.72; P = 0.008) were identified risk factors for hepatitis flare after adjustment of baseline ALT level.

On the other hand, the use of biological therapy was not linked to an increase risk of hepatitis flare (aHR, 1.79; 95% CI, 0.79-3.99; P = 0.14). Exposure to steroids was associated with an increased risk of hepatitis flare regardless of the peak dose (<20mg prednisolone daily, 20-40mg daily, or >40mg daily) [aHR, 2.34–4.18].

Finally, 15 patients (4.1%) developed severe icteric hepatitis flare (ALT > 120U/L and bilirubin >38 mmol/L) and the cumulative incidence of severe icteric hepatitis flare were 2.7%, 7.2% and 8.4% at 12 months, 36 months, and 60 months respectively.

“Amongst IBD patients with previous HBV exposure who were treated with biological therapy, thiopurines or steroid, 20.6% developed hepatitis flare.,” the authors wrote “The use of thiopurine and ever exposure to steroid were risk factors for hepatitis flare. The use of biological therapy was not associated with risk of hepatitis flare.”

The study, “Risk of hepatitis flare in patients with previous hepatitis B virus exposure amongst inflammatory bowel disease patients: results from a territory-wide Hong Kong IBD Registry study,” was published online by the European Crohn’s and Colitis Organisation.