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Infection

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HBsAg-negative/anti-HBc-positive patients treated with rituximab: prophylaxis or monitoring to prevent hepatitis B reactivation?

  • Linda Drößler
  • Clara Lehmann
  • Karin Töpelt
  • Dirk Nierhoff
  • Jörg J. Vehreschild
  • Jan Rybniker
  • Michael Hallek
  • Julia Fischer
  • Verena Stormberg
  • Gerd Fätkenheuer
  • Ulrike Wieland
  • Norma JungEmail author
Brief Report
  • 109 Downloads

Abstract

Rituximab (RTX) has been classified as a drug associated with a high risk for hepatitis B virus (HBV) reactivation in HbsAg-negative/anti-HBc-positive patients. However, data on frequency of HBV reactivation are limited especially for RTX monotherapy. Several new recommendations for screening, monitoring and prophylactic antiviral treatment have been published recently. Here, we report the real-life experience in the management and reactivation rate of HbsAg-negative/anti-HBc-positive patients treated with RTX with or without chemotherapy from a large cohort and discuss our results in the light of updated recommendations.

Keywords

Rituximab Hepatitis B Reactivation Risk groups Hematologic diseases Autoimmune diseases Monotherapy 

Notes

Acknowledgements

C.L. is supported by the Federal Joint Committee (G-BA, German Federal Ministry of Health). J.R. is supported by the German Research Foundation (DFG). G.F. and J.J. Vehreschild have received research grants from the German Federal Ministry of Education and Research (BMBF).

Funding

None.

Compliance with ethical standards

Conflict of interest

None to declare. LD, KT, GF, JF, VS, UW, JR, DN stated no conflicts of interest related to the article. JJV has served at the speakers bureau of Pfizer, Merck, Gilead, Basilea and Astellas, received research funding from Astellas, Gilead, Infectopharm, Merck/MSD, Basilea and Pfizer, has received travel assistance from Astellas, Gilead, Merck/MSD and Basilea, and is a consultant to Astellas, Gilead, Basilea and Merck/MSD. MH has received consultancy fee, speaker`s honoraria and research support from Roche/Gentech. CL has received travel grants from Gilead and BMS and speaking honorarium from Gilead, Janssen, ViiV and Abbvie. NJ has received lecture fees from Labor Stein, Novartis, Gilead, MSD, Infectopharm and travel grants from Gilead, Novartis and Basilea.

References

  1. 1.
    Pattullo V. Prevention of Hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol. 2016;22:219–37.CrossRefGoogle Scholar
  2. 2.
    Perrillo RP, Martin P, Lok AS. Preventing hepatitis B reactivation due to immunosuppressive drug treatments. JAMA. 2015;313:1617–8.CrossRefGoogle Scholar
  3. 3.
    Hwang JP, Lok AS. Management of patients with hepatitis B who require immunosuppressive therapy. Nat Rev Gastroenterol Hepatol. 2014;11:209–19.CrossRefGoogle Scholar
  4. 4.
    Reddy KR, Beavers KL, Hammond SP, Lim JK, Falck-Ytter YT. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:215–9.CrossRefGoogle Scholar
  5. 5.
    Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:221–44.CrossRefGoogle Scholar
  6. 6.
    Mitka M. FDA: Increased HBV reactivation risk with ofatumumab or rituximab. JAMA. 2013;310:1664.CrossRefGoogle Scholar
  7. 7.
    EASL. Clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370–98.CrossRefGoogle Scholar
  8. 8.
    Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1–98.CrossRefGoogle Scholar
  9. 9.
    Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63:261–83.CrossRefGoogle Scholar
  10. 10.
    Mikulska M, Lanini S, Gudiol C, Drgona L, Ippolito G, Fernandez-Ruiz M, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biological therapies: an infectious diseases perspective (agents targeting lymphoid cells surface antigens [I]: CD19, CD20 and CD52). Clin Microbiol Infect. 2018;24(Suppl 2):71–82.CrossRefGoogle Scholar
  11. 11.
    Gonzalez SA, Perrillo RP. Hepatitis B virus reactivation in the setting of cancer chemotherapy and other immunosuppressive drug therapy. Clin Infect Dis. 2016;62(Suppl 4):306–13.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Linda Drößler
    • 1
  • Clara Lehmann
    • 1
    • 5
    • 6
  • Karin Töpelt
    • 1
  • Dirk Nierhoff
    • 2
  • Jörg J. Vehreschild
    • 1
    • 5
  • Jan Rybniker
    • 1
    • 5
    • 6
  • Michael Hallek
    • 1
  • Julia Fischer
    • 1
  • Verena Stormberg
    • 3
  • Gerd Fätkenheuer
    • 1
    • 5
  • Ulrike Wieland
    • 4
  • Norma Jung
    • 1
    Email author
  1. 1.Department I of Internal MedicineUniversity of CologneCologneGermany
  2. 2.Department of Gastroenterology and HepatologyUniversity of CologneCologneGermany
  3. 3.Institute of PharmacyUniversity of CologneCologneGermany
  4. 4.Institute of VirologyUniversity of CologneCologneGermany
  5. 5.German Centre for Infection Research (DZIF)Partner Site Bonn-CologneCologneGermany
  6. 6.Center for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany

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