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.
【저자키워드】 Safety, adverse events, protocols &, guidelines, hepatobiliary disease, Preventive medicine, health &, gastrointestinal infections,