SEVERE CLINICAL REBOUND UPON WITHDRAWAL OF CORTICOSTEROID BEFORE INTERFERON THERAPY - INCIDENCE AND RISK-FACTORS

To analyse the incidence and risk factors of clinical rebound and hepa tic decompensation during or upon withdrawal of prednisolone pretreatm ent before interferon (IFN) therapy, two series of Taiwanese patients with chronic viral hepatitis from two independent randomized controlle d trials were compared. Group 1 included 41 patients with chronic hepa titis B who were pretreated with daily prednisolone (30 mg) for 3 week s, 15 mg for 1 week and no prednisolone for 2 weeks prior to lymphobla stoid IFN therapy. Group 2 consisted of 59 patients with chronic hepat itis B who were pretreated with daily prednisolone (40 mg) for 2 weeks , 30 mg prednisolone for 2 weeks, 20 mg prednisolone for 2 weeks and n o prednisolone for 2 weeks prior to IFN alpha-2a therapy. Clinical reb ound developed more frequently in group 2 (67.8%) than in group 1 pati ents (41.5%, P < 0.01). The peak serum transaminase levels of group 1 and 2 patients during clinical rebound were similar. Icteric and sympt omatic clinical rebound occurred in four (one cirrhotic) group 2 patie nts. The incidence of hepatic decompensation was 3.4% in group 2 patie nts, or 5.0% in group 2 patients with clinical rebound. Patients pretr eated with a higher dose (40 mg) of prednisolone (odds ratio 3.0; 95% CI 1.3-6.6; P < 0.01) and non-cirrhotic patients (odds ratio 6.2; 95% CI 1.2-32.1; P < 0.02) tended to suffer from clinical rebound more fre quently. However, once clinical rebound develops in cirrhotic patients , the relative risk of decompensation is 16 times that of non-cirrhoti c patients. These results suggest that clinicians should be cautious i n prescribing a short course of corticosteroids for patients with chro nic viral hepatitis, because hepatic decompensation might occur in Ori ental people with or without cirrhosis.