Interferon‐beta, prednisolone and lamivudine combination in acute exacerbation of chronic hepatitisBduring pregnancy

Abstract

Dear Editor, We read with great interest the recently published case report by Koh et al. describing acute exacerbation of hepatitis B in a pregnant woman who was treated with lamivudine (LAM), interferon (IFN)-b and steroids early in the second trimester. Antiviral treatment is advised for pregnant women at risk of hepatic decompensation. In order to reduce the risk of hepatic destruction, antiviral therapy should be continued during pregnancy when there is clear hepatic fibrosis. LAM, adefovir and entecavir are listed by the US Food and Drug Administration as pregnancy category C drugs, and telbivudine and tenofovir are listed as category B drugs. However, in experiences with HIV positive women, use of LAM in pregnant women with hepatitis B virus has yielded much data regarding its safety. Therefore, based on these data, tenofovir, LAM or telbivudine could be considered to be safe in the pregnancy. However, adefovir and entecavir were not suggested to be used during pregnancy. Moreover, IFN and pegylated IFN are contraindicated in pregnancy. Also, the use of steroids in acute exacerbation of hepatitis B is not indicated because they have no effect on the resolution of chronic hepatitis B, and steroids may increase the rate of relapse due to immune suppression. IFN-b has been demonstrated to be useful in patients with multiple sclerosis. But, according to our knowledge, IFN-1-b treatment is recommended to be stopped during pregnancy. Moreover, IFN treatment during pregnancy may be harmful by causing spontaneous abortion or congenital defects. So, only LAM monotherapy was sufficient for acute exacerbation of hepatitis B in this case, and the reason was not clear why they used LAM, steroid and IFN-b combination for treatment of their case.