Dexamethasone treatment is associated with a higher HBsAg sero-clearance rate in HBeAg-positive patients with hepatitis B flares.

Abstract

Purpose: Short-term dexamethasone has been used in patients with chronic hepatitis B flares to reduce inflammation in the liver. We aim to identify the potential population that may benefit from dexamethasone treatment.

Methods: A retrospective cohort study was conducted involving 856 hospitalized hepatitis B e antigen-positive patients with chronic hepatitis B flares. The primary endpoint was the 1-year incidence of hepatitis B surface antigen (HBsAg) sero-clearance after the hospital admission. The hazard ratio (HR) and 95 % confidence interval (CI) were calculated using the Cox proportional hazards regression model.

Results: Dexamethasone treatment was associated with a higher incidence of HBsAg sero-clearance (adjusted HR: 3.561, 95 % CI: 1.281-9.902, P = 0.015). These results were further confirmed using the propensity score matching method (HR: 13.115, 95 % CI: 1.705-100.886, P = 0.013). In addition, a faster total bilirubin decrease was observed under dexamethasone treatment (0.57 × upper limit of normal [ULN] per day vs. 0.11 × ULN per day, P < 0.001). Importantly, patients with alanine aminotransferase (ALT) ≥ 30 × ULN and platelet counts ≥ 110 × 10⁹/L were identified as the beneficial population for dexamethasone treatment. These patients showed a higher incidence of HBsAg sero-clearance (39.3 % vs. 11.3 %, P < 0.001; HR: 5.524, 95 % CI: 1.192-25.607, P = 0.029), and faster total bilirubin decline.

Conclusion: Our study confirmed the beneficial role of low-dose and short-term dexamethasone treatment in flare patients, particularly in patients with ALT ≥ 30 × ULN and platelet counts ≥ 110 × 10⁹/L.