Abstract:
OBJECTIVE:Hepatitis B reactivation (HBr) is strongly associated with rituximab therapy. Guidelines advise hepatitis B screening and use of preventive nucleoside analogue (NA) in patients at risk. In this study, we examined screening trends, post-screening interventions and outcomes in patients receiving rituximab in light of recommendations. DESIGN:Retrospective, observational study. SETTING:Single, tertiary care centre in the USA. PARTICIPANTS:Patients receiving rituximab from January 2005 to December 2017. PRIMARY OUTCOME:Trends of hepatitis B screening prior to initiation of rituximab. SECONDARY OUTCOME:Results of hepatitis B screening, use of preventive NA therapy and HBr incidence. RESULTS:Over 13 years, 2219 patients received rituximab. Screening, with at least hepatitis B core antibody (anti-HBc) prior to the first dose of rituximab, improved from 20% to 97%. Because only 4.5% of patients had a positive anti-HBc, the overall HBr incidence was very low (0.42%). In susceptible patients, the incidence of HBr was 8%. In at-risk patients given preventive NA, 96% remained free of HBr. However, only 23% received a preventive NA and no temporal improvement in compliance was seen. Of those with HBr, 87.5% were hepatitis B surface antigen (HbsAg-)/anti-HBc+. CONCLUSIONS:In those treated with rituximab, we demonstrated near-universal anti-HBc screening. Screening unlinked to preventive NA use, in those who are anti-HBc+, is ineffective in reducing HBr. HBr has a high fatality rate. The majority of cases occurred in those who were HBsAg negative. Efforts are needed to educate providers who use rituximab not only to screen for anti-HBc, but to provide preventive NA to those who test positive.
journal_name
BMJ Openjournal_title
BMJ openauthors
Haider M,Flocco G,Lopez R,Carey Wdoi
10.1136/bmjopen-2020-043672subject
Has Abstractpub_date
2020-12-15 00:00:00pages
e043672issue
12issn
2044-6055pii
bmjopen-2020-043672journal_volume
10pub_type
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