A combination treatment of entecavir and early-phase corticosteroid in severe exacerbation of chronic hepatitis B

Abstract

Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy, 20%-30% have a fatal outcome. In this report, we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid. In both cases, rapid reductions in serum hepatitis B virus (HBV)-DNA levels were observed, and corticosteroid was stopped after serum HBV-DNA levels became undetectable. Entecavir treatment was continued. Generally, entecavir treatment reduced serum HBV-DNA levels rapidly, although the improvement in liver function was delayed by a few weeks. During this time lag, liver cell injury continued and the disease progressed. Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration. A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B.

Figure 1

Patient clinical course. ALT: Alanine aminotransferase; PT: Prothrombin activity; T. Bil: Total bilirubin; HBV DNA: Hepatitis B virus DNA. At 6 wk, his serum transaminase level was normalized. At 12 wk, his serum HBV-DNA level became 3.3 LGE/mL and prednisolone was stopped.

Figure 2

Patient clinical course. ALT: Alanine aminotransferase; PT: Prothrombin activity; T. Bil: Total bilirubin; HBV DNA: Hepatitis B virus DNA. At 8 wk, her serum transaminase level was normalized. At 15 wk, her serum HBV-DNA level became undetectable and the prednisolone was stopped.