Prevalence of Corticosteroid Use and Gaps in HBV Reactivation Prophylaxis Among Inpatients

Background: Adverse effects begin to increase when the corticosteroid (CS) dose exceeds 10 - 15 mg/day of prednisolone equivalent. One such effect is the possible reactivation of infections like chronic hepatitis B (CHB). In countries where the prevalence of hepatitis B surface antigen (HBsAg) exceeds 2%, hepatitis B virus (HBV) screening should be performed before starting immunosuppressive therapy. Objectives: This study evaluated CS use rates in inpatients and HBV screening data in these patients. Methods: This multicenter study used a point-prevalence design. On January 28, 2023, all inpatients at the included centers were evaluated for current treatment, and patients receiving CS were identified. Medical records and hospital databases were searched for HBV serologic tests in these patients. Results: A total of 6818 inpatients from 22 centers were evaluated, and the rate of CS use was 10.6%. Clinics with the highest CS use were pulmonary diseases (47.6%) and rheumatology (40.6%). The most common indications were respiratory system diseases (57.8%) and malignancy (6.2%). It was determined that only 22.6% of all patients receiving CS underwent adequate screening for HBV. Examination of CS use revealed 6 cases (3.7%) with high risk, 8 cases (4.9%) with moderate risk, and 35 cases (21.3%) with low risk of CHB reactivation. Fifty-seven patients (34.8%) with adequate screening were consulted to the infectious disease clinic for the risk of CHB reactivation. Of these, 9 (15.8%) were started on CHB prophylaxis. Conclusions: Our study found that, despite the high rate of CS use of 10.6%, only 22.6% of CS users had adequate screening for CHB prophylaxis. Despite Turkey's endemic status, the limited attention paid to this issue by healthcare professionals is worrying.