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Matsumoto K, Miyake Y, Miyatake H, Takahara M, Imada T, Yagi S, Toyokawa T, Nakatsu M, Ando M, Hirohata M. A combination treatment of entecavir and early-phase corticosteroid in severe exacerbation of chronic hepatitis B. World J Gastroenterol 2009; 15(13): 1650-1652 [PMID: 19340912 DOI: 10.3748/wjg.15.1650]
Kazuyuki Matsumoto, Hirokazu Miyatake, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata, Department of Internal Medicine, Mitoyo General Hospital, Kanonji 769-1695, Japan
Yasuhiro Miyake, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
Author contributions: Matsumoto K and Miyake Y analyzed the data and wrote the paper; Miyatake H, Takahara M, Imada T, Yagi S, Toyokawa T, Nakatsu M carried out patient care; Ando M and Hirohata M helped by supervising and approving the final manuscript.
Correspondence to: Yasuhiro Miyake, MD, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. miyake43@md.okayama-u.ac.jp
Telephone: +81-86-2357219
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Received: December 8, 2008 Revised: February 9, 2009 Accepted: February 16, 2009 Published online: April 7, 2009
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.
