The Combination of Nucleotide Analog Therapy and Steroid Pulse Therapy for Acute HBV Infection Effectively Promotes HBV Clearance

Takeshi Goya,Shigeki Tashiro,Miho Kurokawa,Yoshihiro Ogawa,Motoi Takahashi,Tomoyuki Kurashige,Tomomi Aoyagi,Masatake Tanaka,Koji Imoto,Motoyuki Kohjima,Hideo Suzuki,Masaki Kato

doi:10.3390/gastroent13010001

Takeshi Goya, Shigeki Tashiro + Show 10 more

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https://doi.org/10.3390/gastroent13010001

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Abstract

Acute hepatitis B virus (HBV) infection occasionally progresses to acute liver failure, often with poor prognosis. The appropriate pharmacological approach is yet to be established. Although nucleotide analogs (NA) and corticosteroids are candidates for the treatment of acute HBV infection, their therapeutic effects, especially their effect on HBV clearance, remain unclear. To clarify effects on the HBV clearance of combination therapy of NA and steroid pulse therapy (SPT) for acute HBV infection, we first analyze the effectiveness of this therapy in patients with HBV infection compared with NA monotherapy (NAM). Of the 57 consecutive patients with acute hepatitis B infection from May 2007 to December 2018, we have included 25 patients for this study, whom we followed up until HBV clearance. According to the administration of NA and SPT, we divided patients into two groups (NAM group and NA + SPT group) and compared their results. Of the 25 patients, 10 received NAM, whereas 15 received NA + SPT. There were no appreciable adverse effects related to SPT. The time required for the clearance of HBsAg (76 (43–116) days vs. 26 (14–51) days, p = 0.0418) and HBV-DNA (NAM group vs. NA + SPT group: 180 (83.5–220) vs. 69 (43–136) days, p = 0.0420) was significantly shorter in the NA + SPT group than in the NAM group. The hazard ratio of NA + SPT for the clearance of HBsAg and HBV-DNA were 0.45 (0.19–1.09) and 0.35 (0.14–0.89), respectively. In conclusion, we showed that NA + SPT promoted HBV elimination. These findings support the use of the NA + SPT combination for acute HBV infection without the concern of persistent HBV infection.

Highlights

Acute hepatitis B virus (HBV) is a partially double-stranded DNA virus that belongs to the Hepadnaviridae family
We investigated the efficacy of the combination of nucleotide analogs (NA) and steroid pulse therapy (SPT) for acute HBV infection
The differences were not statistically significant, the greater decrease in ALT and increase in PT in the NA + SPT group than in the NA monotherapy (NAM) group might suggest the therapeutic effect of NA + SPT on the inhibition of liver inflammation and the improvement of liver function

Summary

Introduction

Acute hepatitis B virus (HBV) is a partially double-stranded DNA virus that belongs to the Hepadnaviridae family. It is estimated that 296 million people are chronically infected with HBV, with 1.5 million new infections occurring each year [1]. Acute HBV infection can occasionally progress into acute liver failure (ALF), often with poor prognosis. In Japan, 12.4% of acute liver disease cases and 20.3% of ALF or acute-on-chronic liver failure cases are reportedly caused by HBV [2]. Acute HBV infection is considered a major health problem, and an appropriate pharmacological approach to solving this problem is needed. Nucleotide analogs (NA) and corticosteroids are candidates for the therapy of acute HBV infection, the therapeutic effects of these drugs remain unclear

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