Vol.:(0123456789) 1 3 International Journal of Clinical Pharmacy https://doi.org/10.1007/s11096-017-0584-6 RESEARCH ARTICLE The prevalence and risk factors of hepatitis B fares in chronic hepatitis B patients receiving glucocorticoid pulse therapy Ying‑Cheng Lin 1  · Shou‑Wu Lee 1,2  · Hong‑Zen Yeh 1,3  · Chi‑Sen Chang 1,2  · Sheng‑Shun Yang 1,3 Received: 11 May 2017 / Accepted: 20 December 2017 © Springer International Publishing AG, part of Springer Nature 2018 Abstract Background The frequency and risks of hepatitis B reactivation in patients receiving glucocorticoid pulse therapy has not been reported. Objective The aim of our study was to investigate the possibility of glucocorticoid pulse therapy related hepatitis B fare. Setting A Taiwanese tertiary hospital. Methods Chronic hepatitis B patients underwent glucocorticoid pulse therapy were retrospectively collected. The prevalence of hepatitis B fare was counted, and the statistic analysis with logistic regression was adapted to assess the associated risk factors. Main outcome measure The prevalence and associated risk factors of the individuals with hepatitis B fare after glucocorticoid pulse therapy were collected and analyzed. Results A total of 112 patients were identifed. Forty patients had received prophylactic antiviral therapy and none of them developed hepatitis B fare. Among the 72 patients who had not received antiviral prophylaxis, 11 of them (15.3%) experienced hepatitis B fares. Those individuals with hepatitis B fares, comparing to those without, were younger (37.4 ± 13.3 vs. 46.0 ± 11.1, p = 0.038), had higher ratio of HBeAg positivity (50 vs. 15.9%, p = 0.017), higher percentage of high hepatitis B viral load (81.8 vs. 8.3%, p = 0.002), higher maintenance glucocorticoid dose (prednisone or equivalent 22.7 ± 14.9 vs. 10.7 ± 12.4 mg, p = 0.003) and higher ratio of cyclophosphamide use (27.3 vs. 1.6%, p = 0.010). After multivariate analysis, only higher dose of maintenance glucocorticoid was related to hepatitis B fare (odds ratio, 1.08; 95% CI, 1.01–1.16). Conclusion A higher maintenance glucocorticoid dosage is associated with the risk of hepatitis B fare after glucocorticoid pulse therapy. No hepatitis B fare occurred in patients receiving prophylactic antiviral therapy before glucocorticoid pulse therapy. Keywords Glucocorticoid pulse therapy · HBV · Hepatitis B fare · Immunosuppressive therapy Impacts on practice • Patients with a chronic hepatitis B infection might experi- ence a severe hepatitis B fare after glucocorticoid pulse therapy. • The risk of the hepatitis B fare correlates with the dose of glucocorticoid maintenance after pulse therapy. • Antiviral prophylaxis with nucleos(t)ide analogues before glucocorticoid pulse therapy is able to prevent a hepatitis B fare. Introduction Hepatitis B fare is defned as an event with an abrupt rise in alanine aminotransferase (ALT) levels to > 5 times the upper limit of normal levels during chronic hepatitis B virus (HBV) infection [1]. It has been reported to occur Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11096-017-0584-6) contains supplementary material, which is available to authorized users. * Sheng-Shun Yang yansh@vghtc.gov.tw 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec 4, Xi-Tun District, Taichung 40705, Taiwan 2 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 3 Faculty of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan