World J Gastroenterol 2005 February;11(8):1109-1114

Importance of adequate immunosuppressive therapy for the recovery of
patients with "life-threatening" severe exacerbation of chronic hepatitis B

Fujiwara K, Yokosuka O, Kojima H, Kanda T, Saisho H, Hirasawa H, Suzuki H.

Department of Medicine and Clinical Oncology, Graduate School of Medicine,
Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
yokosukao@...

AIM: Hepatitis B virus (HBV) re-activation often occurs spontaneously or
after withdrawal of immunosuppressive therapy in patients with chronic
hepatitis B. Severe exacerbation, sometimes developing into fulminant
hepatic failure, is at high risk of mortality. The efficacy of
corticosteroid therapy in "clinically severe" exacerbation of chronic
hepatitis B has not been well demonstrated. In this study we evaluated the
efficacy of early introduction of high-dose corticosteroid therapy in
patients with life-threatening severe exacerbation of chronic hepatitis B.
METHODS: Twenty-two patients, 14 men and 8 women, were defined as "severe"
exacerbation of chronic hepatitis B using uniform criteria and enrolled in
this study. Eleven patients were treated with corticosteroids at 60 mg or
more daily with or without anti-viral drugs within 10 d after the diagnosis
of severe disease ("early high-dose" group) and 11 patients were either
treated more than 10 d or untreated with corticosteroids ("non-early
high-dose" group). RESULTS: Mean age, male-to-female ratio, mean prothrombin
time (PT) activity, alanine transaminase (ALT) level, total bilirubin level,
positivity of HBeAg, mean IgM-HBc titer, and mean HBV DNA polymerase
activity did not differ between the two groups. Ten of 11 patients of the
"early high-dose" group survived, while only 2 of 11 patients of the
"non-early high-dose" group survived (P<0.001). During the first 2 wk after
the introduction of corticosteroids, improvements in PT activities and total
bilirubin levels were observed in the "early high-dose" group. Both ALT
levels and HBV DNA polymerase levels fell in both groups. CONCLUSION: The
introduction of high-dose corticosteroid can reverse deterioration in
patients with "clinically life-threatening" severe exacerbation of chronic
hepatitis B, when used in the early stage of illness.