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Aguirre A, Yazdany J. Hepatitis B Screening Before Biologic or Targeted Synthetic Disease-modifying Antirheumatic Drug Therapy: Many Roads to Improvement. J Rheumatol 2021; 49:1-4. [PMID: 34725177 DOI: 10.3899/jrheum.211000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Alfredo Aguirre
- A. Aguirre, MD, Clinical Fellow, J. Yazdany, MD, MPH, Professor, Division of Rheumatology, University of California, San Francisco, California, USA.
| | - Jinoos Yazdany
- A. Aguirre, MD, Clinical Fellow, J. Yazdany, MD, MPH, Professor, Division of Rheumatology, University of California, San Francisco, California, USA
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2
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Leber K, Otten HMJMMB, Brandjes DPM, Claassen MAA, Lauw FN. Clinical practice of hepatitis B screening in patients starting with chemotherapy: A survey among Dutch oncologists. Eur J Cancer Care (Engl) 2021; 30:e13495. [PMID: 34310787 PMCID: PMC9285452 DOI: 10.1111/ecc.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Screening for hepatitis B virus (HBV) before chemotherapy is recommended by international guidelines; still, the HBV screening rate is low, and patients remain at risk for HBV reactivation (HBVr). Because HBVr is a serious and preventable condition, we conducted a survey to evaluate the screening behaviour of oncologists in the Netherlands. METHODS We conducted an anonymous digital survey by email to all practicing medical oncologists. The surveys were sent in two session, the first one in 2017 and the second one in 2019. Questions included HBV screening procedures, reasons for screening and experience with HBVr. RESULTS Among the 110 respondents, 29 (27%) followed a standardised protocol. Overall, 13 (12%) oncologists screened all patients, 76 (70%) only screened patients they considered as high risk and 19 (18%) did not screen anyone. Fourteen percent of the respondents experienced a HBVr in one of their patients. CONCLUSION This survey suggests that universal HBV screening is not common practice and usually patients considered as at risk for HBVr are screened, while this group is not always properly identified. Introduction of a national protocol for HBV screening and adjustment of the Dutch oncology guidelines might contribute to a reduction of HBVr during chemotherapy.
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Affiliation(s)
- Karin Leber
- Department of Internal Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | | | - Dees P M Brandjes
- Department of Internal/Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Mark A A Claassen
- Department of Internal Medicine/Infectious Diseases, Rijnstate Hospital, Arnhem, The Netherlands
| | - Fanny N Lauw
- Department of Internal Medicine/Infectious Diseases, Medical Center Jan van Goyen, Amsterdam, The Netherlands
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3
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Sun WC, Tang PL, Chen WC, Tsay FW, Wang HM, Tsai TJ, Kao SS, Cheng JS, Tsai WL. Hepatitis B Virus Screening Before Cancer Chemotherapy in Taiwan: A Nationwide Population-Based Study. Front Med (Lausanne) 2021; 8:657109. [PMID: 34336877 PMCID: PMC8319464 DOI: 10.3389/fmed.2021.657109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Reactivation of the hepatitis B virus (HBV) during cancer chemotherapy is a severe and sometimes fatal complication. In 2009, the National Health Insurance (NHI) in Taiwan recommended and reimbursed screening for HBV infection and prophylactic antiviral therapy before cancer chemotherapy. In this study, we determined the HBV screening rate in patients with cancer undergoing chemotherapy in Taiwan. Methods: We retrospectively collected data from the National Health Insurance Research Database on patients who received systemic chemotherapy for solid or hematologic cancers from January 2000 through December 2012. We defined HBV screening based on testing for serum HBsAg within 2 years of the first chemotherapy commencement. We calculated overall and annual HBV screening rates in all patients and subgroups of age, gender, cancer type, hospital level, physician's department, and implementation of NHI reimbursement for HBV screening before cancer chemotherapy. Results: We enrolled 379,639 patients. The overall HBV screening rate was 45.9%. The screening rates were higher in males, those with hematological cancer, those at non-medical centers and medical departments. The HBV screening rates before (2000–2008) and after the implementation of NHI reimbursement (2009–2012) were 38.1 and 57.5%, respectively (p < 0.0001). The most common practice pattern of HBV screening was only HBsAg (64.6%) followed by HBsAg/HBsAb (22.1%), and HBsAg/HBcAb/HBsAb (0.7%) (p < 0.0001). The annual HBV screening rate increased from 31.5 to 66.3% (p < 0.0001). The screening rates of solid and hematological cancers significantly increased by year; however, the trend was greater in solid cancer than in hematological cancer (35.9 and 26.2%, p < 0.0001). Conclusions: The HBV screening rate before cancer chemotherapy was fair but increased over time. These figures improved after implementing a government-based strategy; however, a mandatory hospital-based strategy might improve awareness of HBV screening and starting prophylactic antiviral therapy before cancer chemotherapy.
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Affiliation(s)
- Wei-Chih Sun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Wen-Chi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Woei Tsay
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huay-Min Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sung-Shuo Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Shiung Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Lun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management. Viruses 2019; 11:v11090858. [PMID: 31540124 PMCID: PMC6784078 DOI: 10.3390/v11090858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022] Open
Abstract
It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.
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5
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Wu JQ, Song YP, Su LP, Zhang MZ, Li W, Hu Y, Zhang XH, Gao YH, Niu ZX, Feng R, Wang W, Peng JW, Li XL, Ouyang XN, Wu CP, Zhang WJ, Zeng Y, Xiao Z, Liang YM, Zhuang YZ, Wang JS, Sun ZM, Bai H, Cui TJ, Feng JF. Three-year Follow-up on the Safety and Effectiveness of Rituximab Plus Chemotherapy as First-Line Treatment of Diffuse Large B-Cell Lymphoma and Follicular Lymphoma in Real-World Clinical Settings in China: A Prospective, Multicenter, Noninterventional Study. Chin Med J (Engl) 2018; 131:1767-1775. [PMID: 30058572 PMCID: PMC6071449 DOI: 10.4103/0366-6999.237401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prospective real-life data on the safety and effectiveness of rituximab in Chinese patients with diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) are limited. This real-world study aimed to evaluate long-term safety and effectiveness outcomes of rituximab plus chemotherapy (R-chemo) as first-line treatment in Chinese patients with DLBCL or FL. Hepatitis B virus (HBV) reactivation management was also investigated. METHODS A prospective, multicenter, single-arm, noninterventional study of previously untreated CD20-positive DLBCL or FL patients receiving first-line R-chemo treatment at 24 centers in China was conducted between January 17, 2011 and October 31, 2016. Enrolled patients underwent safety and effectiveness assessments after the last rituximab dose and were followed up for 3 years. Effectiveness endpoints included progression-free survival (PFS) and overall survival (OS). Safety endpoints were adverse events (AEs), serious AEs, drug-related AEs, and AEs of special interest. We also reported data on the incidence of HBV reactivation. RESULTS In total, 283 previously untreated CD20-positive DLBCL and 31 FL patients from 24 centers were enrolled. Three-year PFS was 59% (95% confidence interval [CI]: 50-67%) for DLBCL patients and 46% (95% CI: 20-69%) for FL patients. For DLBCL patients, multivariate analyses showed that PFS was not associated with international prognostic index, tumor maximum diameter, HBV infection status, or number of rituximab treatment cycles, and OS was only associated with age >60 years (P < 0.05). R-chemo was well tolerated. The incidence of HBV reactivation in hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative/hepatitis B core antibody-positive patients was 13% (3/24) and 4% (3/69), respectively. CONCLUSIONS R-chemo is effective and safe in real-world clinical practice as first-line treatment for DLBCL and FL in China, and that HBV reactivation during R-chemo is manageable with preventive measures and treatment. TRIAL REGISTRATION ClinicalTrials.gov, NCT01340443; https://clinicaltrials.gov/ct2/show/NCT01340443.
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Affiliation(s)
- Jian-Qiu Wu
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210008, China
| | - Yong-Ping Song
- Department of Hematology, Henan Cancer Hospital, Zhengzhou, Henan 450000, China
| | - Li-Ping Su
- Department of Hematology, Shanxi Cancer Hospital, Taiyuan, Shanxi 030013, China
| | - Ming-Zhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Wei Li
- Department of Oncology, Jilin University First Affiliated Hospital, Changchun, Jilin 130000, China
| | - Yu Hu
- Department of Hematology, Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430072, China
| | - Xiao-Hong Zhang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Yu-Huan Gao
- Department of Hematology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Zuo-Xing Niu
- Department of Oncology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, Shandong 250000, China
| | - Ru Feng
- Department of Hematology, Medical University Nanfang Hospital, Guangzhou, Guangdong 510000, China
| | - Wei Wang
- Department of Oncology, Guangdong Foshan First Hospital, Foshan, Guangdong 528000, China
| | - Jie-Wen Peng
- Department of Oncology, Guangdong Zhongshan People's Hospital, Zhongshan, Guangdong 528403, China
| | - Xiao-Lin Li
- Department of Hematology, Xiangya Hospital Central South University, Changsha, Hunan 410008, China
| | - Xue-Nong Ouyang
- Department of Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian 350001, China
| | - Chang-Ping Wu
- Department of Oncology, Changzhou First People's Hospital, Changzhou, Jiangsu 213000, China
| | - Wei-Jing Zhang
- Department of Oncology, 307 Hospital of Chinese People's Liberation Army, Beijing 100070, China
| | - Yun Zeng
- Department of Hematology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650221, China
| | - Zhen Xiao
- Department of Hematology, Affiliated Hospital of Neimenggu Medical College, Hohhot, Huhehaote, Inner Mongolia 010050, China
| | - Ying-Min Liang
- Department of Hematology, The Fourth Military Medical University Affiliated Tangdu Hospital, Xi'an, Shaanxi 710038, China
| | - Yong-Zhi Zhuang
- Department of Oncology, Daqing General Hospital Group Oilfield General Hospital, Daqing, Heilongjiang 163001, China
| | - Ji-Shi Wang
- Department of Hematology, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou 550004, China
| | - Zi-Min Sun
- Department of Hematology, Anhui Provincial Hospital, Hefei, Anhui 23000, China
| | - Hai Bai
- Department of Hematology, Lanzhou Military Hospital, Lanzhou, Gansu 730046, China
| | - Tong-Jian Cui
- Department of Oncology, Fujian Provincial Hospital, Fuzhou, Fujian 350001, China
| | - Ji-Feng Feng
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210008, China
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Gonzalez SA, Perrillo RP. Hepatitis B Virus Reactivation in the Setting of Cancer Chemotherapy and Other Immunosuppressive Drug Therapy. Clin Infect Dis 2017; 62 Suppl 4:S306-13. [PMID: 27190320 DOI: 10.1093/cid/ciw043] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus reactivation (HBVr) is an important complication of immunosuppressive drug therapy (ISDT). It can occur with active or resolved hepatitis B virus (HBV) infection with a clinical spectrum that ranges from mild elevations in liver tests to fulminant hepatic failure. The risk of it occurring is determined by the interplay between HBV serological status, level of viremia, and the immunosuppressive potency of the drug(s) used. Reactivation is most common during treatment of hematologic malignancies but also occurs with chemotherapy for breast cancer and numerous other solid organ malignancies, organ transplant, and immune suppression for nonmalignant conditions. The expansion of new biologic treatments for malignant and nonmalignant disorders has enlarged the population at risk. Increased awareness of HBVr among healthcare providers who prescribe ISDT, adoption of routine HBV screening, and linking the results of screening to antiviral prophylaxis are needed to reduce the incidence of this potentially fatal but preventable disorder.
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Affiliation(s)
- Stevan A Gonzalez
- Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center, Fort Worth
| | - Robert P Perrillo
- Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
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7
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Willson ML, Vernooij RW, Gagliardi AR, Armstrong M, Bernhardsson S, Brouwers M, Bussières A, Fleuren M, Gali K, Huckson S, Jones S, Lewis SZ, James R, Marshall C, Mazza D. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review. J Clin Epidemiol 2017; 86:25-38. [DOI: 10.1016/j.jclinepi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 01/26/2023]
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8
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Schmajuk G, Tonner C, Trupin L, Li J, Sarkar U, Ludwig D, Shiboski S, Sirota M, Dudley RA, Murray S, Yazdany J. Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab. Medicine (Baltimore) 2017; 96:e6528. [PMID: 28353614 PMCID: PMC5380298 DOI: 10.1097/md.0000000000006528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively.We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population.
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Affiliation(s)
- Gabriela Schmajuk
- Division of Rheumatology, University of California-San Francisco
- Veterans Affairs Medical Center – San Francisco
| | - Chris Tonner
- Division of Rheumatology, University of California-San Francisco
| | - Laura Trupin
- Division of Rheumatology, University of California-San Francisco
| | - Jing Li
- Division of Rheumatology, University of California-San Francisco
| | - Urmimala Sarkar
- Center for Vulnerable Populations & Division of General Internal Medicine at the Zuckerberg San Francisco General Hospital, Department of Medicine, University of California-San Francisco
| | - Dana Ludwig
- University of California-San Francisco , Enterprise Information and Analytics
| | - Stephen Shiboski
- Department of Epidemiology and Biostatistics, University of California-San Francisco
| | - Marina Sirota
- Institute for Computational Health Sciences, University of California-San Francisco
| | - R. Adams Dudley
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco
| | - Sara Murray
- Department of Medicine, University of California-San Francisco
| | - Jinoos Yazdany
- Division of Rheumatology, University of California-San Francisco
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9
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Paul S, Shuja A, Tam I, Kim EM, Kang S, Kapulsky L, Viveiros K, Lee H. Gastroenterologists Have Suboptimal Hepatitis B Virus Screening Rates in Patients Receiving Immunosuppressive Therapy. Dig Dis Sci 2016; 61:2236-2241. [PMID: 26993822 PMCID: PMC6484859 DOI: 10.1007/s10620-016-4118-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 03/06/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B reactivation in patients undergoing immunosuppressive therapy can lead to liver failure and death. Prior studies have shown suboptimal hepatitis B screening rates, but few have compared screening rates across specialties or factors associated with screening. METHODS A retrospective study was performed using a hospital-based chemotherapy database and outpatient pharmacy records from January 1999 to December 2013. HBV screening rates prior to initiation of immunosuppression were determined. Multivariate analysis was used to determine predictors of HBV screening. RESULTS Of the 4008 study patients, 47 % were screened prior to receiving immunosuppressive therapy; only 48 % on rituximab and 45 % of those on anti-TNF therapy were screened. Transplant specialists screened most frequently (85 %) while gastroenterologists screened the least (34 %). Factors significantly associated with HBV screening were younger age, Asian race, use of anti-rejection therapy, and treatment by a transplant specialist (p < 0.001). CONCLUSION HBV screening prior to immunosuppressive therapy is suboptimal, especially among gastroenterologists. Efforts to improve screening rates in at risk populations are needed.
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Affiliation(s)
- Sonali Paul
- Division of Gastroenterology and Hepatology, Massachusetts General Hospital, 55 Fruit Street, Blake 4, Boston, MA 02114,
| | - Asim Shuja
- Department of Gastroenterology, University of Florida College of Medicine, 655 West 8 Street, Jacksonville, FL 23309,
| | - Idy Tam
- Division of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA 02111,
| | - Eun Min Kim
- Division of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA 02111,
| | - Sandra Kang
- Tufts University School of Medicine, 145 Harrison Street, Boston, MA 02111,
| | - Leonid Kapulsky
- Tufts University School of Medicine, 145 Harrison Street, Boston, MA 02111,
| | - Kathleen Viveiros
- Division of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233 Boston, MA 02111,
| | - Hannah Lee
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University Medical Center, 1101 East Marshall Street Richmond, Virginia 23298-0663,
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Persistent risk of HBV reactivation despite extensive lamivudine prophylaxis in haematopoietic stem cell transplant recipients who are anti-HBc-positive or HBV-negative recipients with an anti-HBc-positive donor. Clin Microbiol Infect 2016; 22:946.e1-946.e8. [PMID: 27475741 DOI: 10.1016/j.cmi.2016.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/08/2016] [Accepted: 07/16/2016] [Indexed: 02/08/2023]
Abstract
The overall rate of hepatitis B virus (HBV) reactivation was evaluated in a population of 373 haematological stem cell transplant (HSCT) patients treated with lamivudine (LMV) if they were anti-HBc-positive/HBV-DNA-negative recipients or if they were HBV-negative recipients with an anti-HBc-positive donor. The incidence of HBV reactivation was calculated in two groups of autologous (auto) or allogeneic (allo) HSCT patients who were stratified according to their HBV serostatus. The former group included 57 cases: 10 auto-HSCT and 27 allo-HSCT anti-HBc-positive recipients, two auto-HSCT and three allo-HSCT inactive carriers, and 15 allo-HSCT recipients with an anti-HBc-positive donor. Forty-seven (82.4%) patients in this group received LMV prophylaxis (the median (interquartile range, IQR) of LMV treatment was 30 (20-38) months). The second group consisted of 320 anti-HBc-negative auto-HSCT and allo-HSCT recipients with anti-HBc-negative donors. None of these patients received any prophylaxis. Two patients in the first group and two in the second group experienced reactivation of HBV infection, with an incidence of 3.5% (95% CI 0.4-12.1%) and 0.6% (95% CI 0.1-2.2%), respectively. Only one out of four reactivated patients was LMV-treated. The cumulative probability of HBV reactivation at 6 years from HSCT was 15.8% (95% CI 15.2-16.4%). Three of four viral isolates obtained from the HBV-reactivated patients harboured mutations in the immune-active HBsAg-region. In a HSCT population carefully evaluated for HBV prophylaxis, a risk of HBV reactivation persisted in the group of patients who were not LMV-treated. Only one LMV-treated patient experienced reactivation of HBV with a resistant HBV isolate.
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11
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Wu J, Song Y, Su L, Xu L, Chen T, Zhao Z, Zhang M, Li W, Hu Y, Zhang X, Gao Y, Niu Z, Feng R, Wang W, Peng J, Li X, Ouyang X, Wu C, Zhang W, Zeng Y, Xiao Z, Liang Y, Zhuang Y, Wang J, Sun Z, Bai H, Cui T, Feng J. Rituximab plus chemotherapy as first-line treatment in Chinese patients with diffuse large B-cell lymphoma in routine practice: a prospective, multicentre, non-interventional study. BMC Cancer 2016; 16:537. [PMID: 27460571 PMCID: PMC4962436 DOI: 10.1186/s12885-016-2523-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/05/2016] [Indexed: 12/23/2022] Open
Abstract
Background The efficacy and safety of rituximab-based chemotherapy (R-chemo), the standard regimen for patients with diffuse large B-cell lymphoma (DLBCL), which is more common in Asia than in Western countries, are well confirmed in randomized controlled trials (RCTs). However, the safety and effectiveness of R-chemo in patients who are largely excluded from RCTs have not been well characterized. This real-world study investigated the safety and effectiveness of R-chemo as first-line treatment in Chinese patients with DLBCL. Methods Treatment-naive DLBCL patients who were CD20 positive and eligible to receive R-chemo were enrolled with no specific exclusion criteria. Data collected at baseline included age, gender, disease stage, international prognostic index (IPI), B symptoms, extranodal involvement, performance status, and medical history. In the present study, data on safety, treatment effectiveness, and HBV infection management were collected 120 days after the last R-chemo administration. Results Overall, R-chemo was well tolerated. The safety profile of R-chemo in patients with a history of heart or liver disease was well described without any additional unexpected safety concerns. The overall response rate (ORR) in the Chinese patients from this study was 94.2 % (complete response [CR], 55.0 %; CR unconfirmed [CRu] 18.2 %; and partial response [PR], 20.9 %). Compared to patients with no history of disease, the CR and PR rates of patients with a history of heart or liver disease were lower and higher, respectively; this tendency could be in part explained by treatment interruptions in patients with heart or liver diseases. HBsAg positivity and a maximum tumor diameter of ≥7.5 cm negatively correlated with CR + CRu, whereas age and HBsAg positivity negatively correlated with CR. Conclusions This study further validated the safety and effectiveness of R-chemo in Chinese patients with DLBCL. Patients with a history of heart or liver disease may further benefit from R-chemo if preventive measures are taken to reduce hepatic and cardiovascular toxicity. In addition to IPI and tumor diameter, HBsAg positivity could also be a poor prognostic factor for CR in Chinese patients with DLBCL. Trial registration ClinicalTrials.gov #NCT01340443, April 20, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2523-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianqiu Wu
- Jiangsu Cancer Hospital, Nanjing, 210000, China
| | | | - Liping Su
- Shanxi Cancer Hospital, Taiyuan, China
| | - Li Xu
- Shanghai Roche Pharmaceuticals Ltd, Shanghai, China
| | | | - Zhiyun Zhao
- Shanghai Roche Pharmaceuticals Ltd, Shanghai, China
| | - Mingzhi Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Jilin University First Affiliated Hospital, Changchun, China
| | - Yu Hu
- Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohong Zhang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhuan Gao
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zuoxing Niu
- Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, China
| | - Ru Feng
- Nanfang Medical University Nanfang Hospital, Guangzhou, China
| | - Wei Wang
- Guangdong Foshan First Hospital, Foshan, China
| | - Jiewen Peng
- Guangdong Zhongshan People's Hospital, Zhongshan, China
| | - Xiaolin Li
- Xiangya Hospital Central South University, Changsha, China
| | - Xuenong Ouyang
- Fuzhou General Hospital of Nanjing Military Command, Fuzhou, China
| | - Changping Wu
- Changzhou First People's Hospital, Changzhou, China
| | | | - Yun Zeng
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Xiao
- Affiliated hospital of Neimenggu Medical College, Huhehaote, China
| | - Yingmin Liang
- The Fourth Military Medical University Affiliated Tangdu Hospital, Xi'an, China
| | - Yongzhi Zhuang
- Daqing General Hospital Group Oilfield General Hospital, Daqing, China
| | - Jishi Wang
- Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Zimin Sun
- Anhui Provincial Hospital, Hefei, China
| | - Hai Bai
- Lanzhou Military Hospital, Lanzhou, China
| | | | - Jifeng Feng
- Jiangsu Cancer Hospital, Nanjing, 210000, China.
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12
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Hicks LK, Lien K, Chan KKW. ASCO Provisional Clinical Opinion for Hepatitis B Virus Screening Before Cancer Therapy: Are These the Right Tests in the Right Patients? J Oncol Pract 2016; 11:e490-4. [PMID: 26188049 DOI: 10.1200/jop.2015.004945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Lisa K Hicks
- St Michael's Hospital, University of Toronto; and Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelly Lien
- St Michael's Hospital, University of Toronto; and Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- St Michael's Hospital, University of Toronto; and Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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13
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Ikeda M, Yamamoto H, Kaneko M, Oshima H, Takahashi H, Umemoto K, Watanabe K, Hashimoto Y, Ohno I, Mitsunaga S, Okusaka T. Screening rate for hepatitis B virus infection in patients undergoing chemotherapy in Japan. Int J Clin Oncol 2016; 21:1162-1166. [PMID: 27260010 DOI: 10.1007/s10147-016-0995-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to investigate the screening rate for hepatitis B virus (HBV) infection, which is recommended by some guidelines for the prevention of HBV reactivation, in patients undergoing chemotherapy for malignancy in Japan. METHODS The study subjects were 3302 patients who had received first-line chemotherapy for malignancy from Apr 2008 through Mar 2013 utilizing the Claims Database of the Japan Medical Data Center. The proportion of patients who had been tested for HBsAg (P-HBsAg) and the proportion of HBsAg-negative patients who had undergone tests for anti-HBc and anti-HBs (P-HBc/HBsAb) before chemotherapy were investigated. RESULTS P-HBsAg and P-HBc/HBsAb in all 3302 patients were 66.3 and 19.9 %, respectively. P-HBsAg in patients with solid tumors and those with hematological malignancies were 66.1 and 67.5 % (p = 0.61), respectively, and P-HBc/HBsAb were 12.3 and 75.8 % (p < 0.0001), respectively. P-HBsAg in patients from cancer centers and non-cancer centers were 66.9 and 65.5 % (p = 0.43), respectively, and P-HBc/HBsAb were 25.1 and 12.4 % (p < 0.0001), respectively. P-HBsAg in patients encountered before and after the announcement of the Japanese guideline were 51.3 and 67.1 % (p < 0.001), respectively, and P-HBc/HBsAb were 7.9 and 20.4 % (p = 0.01), respectively. CONCLUSIONS The screening rate for HBV among cancer patients scheduled for chemotherapy remains unsatisfactory, especially in patients with solid tumors and those from non-cancer centers. Although the figures are improving after the announcement of the Japanese guideline, intensive measures to improve awareness about HBV reactivation during/after chemotherapy are needed.
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Affiliation(s)
- Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
| | | | | | | | - Hideaki Takahashi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kumiko Umemoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kazuo Watanabe
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yusuke Hashimoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Izumi Ohno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Shuichi Mitsunaga
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
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14
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Brasseur M, Heurgué-Berlot A, Barbe C, Brami C, Rey JB, Vella-Boucaud J, Dabouz F, Deslée G, Grange F, Volet J, Bouché O. Prevalence of hepatitis B and C and sensibility of a selective screening questionnaire in patients receiving chemotherapy for solid tumors. BMC Cancer 2015; 15:999. [PMID: 26694960 PMCID: PMC4688993 DOI: 10.1186/s12885-015-2033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 12/17/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Reactivation of hepatitis B or C virus can occur in patients undergoing chemotherapy. Recommendations for selective or systematic hepatitis B virus testing prior chemotherapy for solid tumors differ. The primary aim was to determine the seroprevalence of hepatitis B or C in a low endemic country. The second objective was to assess the relevance of a questionnaire on hepatitis B/C risk factors to consider a selective screening. METHODS Patients were prospectively tested for hepatitis B/C markers. HBs antigen positive patients and isolated anti-HBc positive patients with detectable viral load received antiviral preventive treatment. Patients or physicians completed the questionnaire on infection risk factors. RESULTS Among the 450 patients included, 388 were tested for all serological markers and had gastrointestinal (63.7%), lung (31.2%) and skin (4.6%) cancers. The prevalence of subjects exposed to hepatitis B virus was 8.5% (33/388). One patient tested positive for HBs antigen and received preventive treatment. Prevalence of subjects exposed to hepatitis C was 1.3% (5/388). The questionnaire sensitivity was 45.5%, 100% and 50% for detecting carriers of hepatitis B, C and one or the other, respectively. CONCLUSIONS Seroprevalence of hepatitis B was low. Selective screening with the questionnaire was insufficiently sensitive. Systematic screening with serological tests prior to chemotherapy in patients with solid tumors is therefore relevant.
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Affiliation(s)
- Mathilde Brasseur
- CHU Reims, Hôpital Robert Debré, Structure Interne d'Hépato-Gastro-Entérologie et Cancérologie Digestive, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Alexandra Heurgué-Berlot
- CHU Reims, Hôpital Robert Debré, Structure Interne d'Hépato-Gastro-Entérologie et Cancérologie Digestive, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Coralie Barbe
- CHU Reims, Hôpital Robert Debré, Unité d'Aide Méthodologique, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Cloé Brami
- CHU Reims, Hôpital Robert Debré, Unité de Médecine Ambulatoire Cancérologie Hématologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Jean-Baptiste Rey
- Institut de Cancérologie Jean Godinot, Département de Pharmacie, Avenue du Génénal Kœnig, Reims, F-51100, France. .,Université de Reims Champagne-Ardenne, Laboratoire EA4691, Avenue du Maréchal Juin, Reims, F-51100, France.
| | - Juliette Vella-Boucaud
- CHU Reims, Hôpital Maison Blanche, Maladies Respiratoires et Allergologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Fadia Dabouz
- CHU Reims, Hôpital Robert Debré, Structure interne de Dermatologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Gaëtan Deslée
- CHU Reims, Hôpital Maison Blanche, Maladies Respiratoires et Allergologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Florent Grange
- CHU Reims, Hôpital Robert Debré, Structure interne de Dermatologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Julien Volet
- CHU Reims, Hôpital Robert Debré, Structure Interne d'Hépato-Gastro-Entérologie et Cancérologie Digestive, Avenue du Génénal Kœnig, Reims, F-51092, France. .,CHU Reims, Hôpital Robert Debré, Unité de Médecine Ambulatoire Cancérologie Hématologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
| | - Olivier Bouché
- CHU Reims, Hôpital Robert Debré, Structure Interne d'Hépato-Gastro-Entérologie et Cancérologie Digestive, Avenue du Génénal Kœnig, Reims, F-51092, France. .,CHU Reims, Hôpital Robert Debré, Unité de Médecine Ambulatoire Cancérologie Hématologie, Avenue du Génénal Kœnig, Reims, F-51092, France.
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15
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Leonard AN, Love BL, Norris LB, Siddiqui SK, Wallam MN, Bennett CL. Screening for viral hepatitis prior to rituximab chemotherapy. Ann Hematol 2015; 95:27-33. [PMID: 26382277 DOI: 10.1007/s00277-015-2502-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/08/2015] [Indexed: 01/17/2023]
Abstract
In 2008, the CDC published guidelines recommending screening of all persons undergoing treatment with rituximab to identify persons at risk of hepatitis B virus (HBV) reactivation. We evaluated implementation of this recommendation in veterans, who are at increased risk of HBV, and determined characteristics of those screened. We also evaluated a control setting, rates of hepatitis C virus (HCV) screening among the same rituximab-treated patients. There are no guidelines that recommend HCV screening prior to initiation of rituximab. Medical records of patients receiving rituximab between January 2006 and December 2012 were reviewed according to two time periods: 2006-2008 (period 1, pre-guidelines) and 2009-2012 (period 2, post-guidelines). Patient demographics, concomitant chemotherapy regimen (protocol, dose, duration), treatment indication, risk factors for hepatitis infection (substance abuse, homelessness, human immunodeficiency virus (HIV)), and HBV/HCV screening status were documented. During the study period, 102 patients were treated with rituximab (49 in period 1 and 53 in period 2). During periods 1 and 2, 22 and 32 % of rituximab-treated patients were screened for HBV, respectively (p = 0.375). Treatment during 2009 was the only significant predictor of HBV screening in the adjusted model (p = 0.01). For HCV during periods 1 and 2, 22 and 21 % of patients were screened, respectively (p = 1.00). There were no significant predictors of HCV screening. Rates of screening for HBV among rituximab-treated patients were low, both before and after dissemination of guidelines recommending universal HBV screening of rituximab-treated patients.
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Affiliation(s)
- A N Leonard
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA
| | - B L Love
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA. .,Department of Research, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.
| | - L B Norris
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA.,Department of Research, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA
| | - S K Siddiqui
- Department of Gastroenterology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA
| | - M N Wallam
- Department of Oncology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA
| | - C L Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA.,Department of Research, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.,Department of Oncology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.,South Carolina Center of Economic Excellence for Medication Safety and Efficacy, Columbia, SC, 29208, USA
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16
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Visram A, Chan KKW, McGee P, Boro J, Hicks LK, Feld JJ. Poor recognition of risk factors for hepatitis B by physicians prescribing immunosuppressive therapy: a call for universal rather than risk-based screening. PLoS One 2015; 10:e0120749. [PMID: 25875198 PMCID: PMC4398053 DOI: 10.1371/journal.pone.0120749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/06/2015] [Indexed: 02/07/2023] Open
Abstract
Background Reactivation of hepatitis B virus (HBV) during immunosuppressive therapy (IST) can lead to severe and even fatal hepatitis but can be largely prevented with prophylactic antiviral therapy. Screening for HBV prior to starting IST is recommended. Both risk-based and universal screening have been recommended by different societies. For effective risk-based screening, physicians must be aware of risk factors for chronic HBV infection. Methods The HBV screening practices prior to starting IST of rheumatologists, medical and hematological oncologists were evaluated by survey and chart review. Country of origin, the primary risk factor for HBV exposure, was determined in all patients. Results Of 140 rheumatology, 79 medical oncology and 53 hematology patients reviewed, 81%, 11% and 81% were deemed to be at high risk of HBV reactivation by their physicians respectively, however only 27%, 6% and 62% (p<0.0001) were actually screened for HBV prior to starting IST. For patients from HBV-endemic regions, more hematology patients (53%) were correctly identified by their physicians as being at high risk of reactivation than rheumatology patients (2.4%, p=0.0001) or medical oncology patients (15%, p=0.009). However actual screening rates were not increased in patients from endemic regions. A total of 81 patients were screened for HBsAg; 2 were positive. Of the 33 patients screened for anti-HBc, 10 (30%) were positive. Conclusions Hematologists, rheumatologists and medical oncologists had low rates of screening for HBV prior to prescribing IST, largely due to poor identification of those at risk for infection. Risk-based screening strategies are unlikely to be effective and should be replaced by universal screening.
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Affiliation(s)
- Alissa Visram
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
- * E-mail:
| | - Kelvin K. W. Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | - Jordana Boro
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Lisa K. Hicks
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
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17
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Pei SN, Chen CH. Risk and prophylaxis strategy of hepatitis B virus reactivation in patients with lymphoma undergoing chemotherapy with or without rituximab. Leuk Lymphoma 2015; 56:1611-8. [PMID: 25248874 DOI: 10.3109/10428194.2014.964699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatitis B virus (HBV) reactivation is a serious but preventable complication for patients with lymphoma receiving systemic therapy. Without antiviral prophylaxis, the HBV reactivation rate is estimated to be > 50% in patients who are positive for hepatitis B surface antigen (HBsAg), and fatal hepatic failure is not uncommon. Current guidelines suggest that routine antiviral prophylaxis should be administered to all HBsAg-positive patients until 6-12 months after completion of chemotherapy. For those who are negative for HBsAg and positive for hepatitis B core antibody, HBV reactivation is uncommon when a conventional dose of chemotherapy is administered. However, with rituximab-containing immunochemotherapy, the HBV reactivation rate is 18% and the clinical course can vary from asymptomatic viremia to fulminant hepatic failure that can be potentially fatal. In this review, we discuss the risk, clinical course and prophylactic strategy of HBV reactivation in patients with lymphoma treated with chemotherapy with or without rituximab.
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18
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Watanabe R, Ishii T, Kobayashi H, Asahina I, Takemori H, Izumiyama T, Oguchi Y, Urata Y, Nishimaki T, Chiba K, Komatsuda A, Chiba N, Miyata M, Takagi M, Kawamura O, Kanno T, Hirabayashi Y, Konta T, Ninomiya Y, Abe Y, Murata Y, Saito Y, Ohira H, Harigae H, Sasaki T. Prevalence of hepatitis B virus infection in patients with rheumatic diseases in Tohoku area: a retrospective multicenter survey. TOHOKU J EXP MED 2015; 233:129-33. [PMID: 24898712 DOI: 10.1620/tjem.233.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hepatitis B virus (HBV) reactivation has been increasingly recognized in patients receiving chemotherapy and immunosuppressive therapy; however, the prevalence of HBV infection and rate of HBV screening in patients with rheumatic diseases remains unclear. In this study, we aimed to assess the prevalence of HBV infection and fulminant HBV hepatitis in patients with rheumatic diseases. We also investigated the rate of HBV screening before immunosuppressive therapy in patients with rheumatic diseases. A retrospective questionnaire survey was conducted in the North-east area (Tohoku) of Japan. Questionnaires, comprising 6 questions, were sent to 318 rheumatologists in May 2010, and responses were gathered until June 2011. In total, 71 rheumatologists (22.3%) responded to the survey. We enrolled 7,650 patients with rheumatoid arthritis (RA) and 1,031 patients with systemic lupus erythematosus (SLE). When limited to institutes at which almost all (≥ 90%) patients were tested for HBV serology, 1.1% (40/3,580) patients with RA and 0.3% (3/1,128) patients with SLE were positive for hepatitis B surface antigen (HBsAg), and 25.2% (177/703) patients with RA and 13.7% (34/248) patients with SLE were positive for hepatitis B core antibody (HBcAb). About one-third of rheumatologists did not check HBsAg and more than half did not check hepatitis B surface antibody (HBsAb) or HBcAb at all before therapy. Fulminant HBV hepatitis was observed in 1 RA patient who was current HBV carrier. In conclusion, the prevalence of HBV infection is high in patients with RA and SLE. HBV screening before immunosuppressive therapy should be strictly performed.
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Affiliation(s)
- Ryu Watanabe
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
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19
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Marignani M, Marzano A, Begini P, Vitolo U, Luminari S, Levis A, Deli I, Gigante E, De Santis E, delle Fave G, Monarca B, Cox MC. Perception of hepatitis B virus infection reactivation-related issues among specialists managing hematologic malignancies: result of an Italian survey. Leuk Lymphoma 2014; 55:2564-71. [PMID: 24471911 DOI: 10.3109/10428194.2013.879712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepatitis B virus (HBV) reactivation strongly affects the practice of physicians dealing with hematological malignancies. In this respect, in collaboration with the Italian Lymphoma Foundation we developed a descriptive study of the real-life approach of physicians caring for patients with these diseases. A questionnaire was designed to explore the perception of HBV reactivation-related issues. Fifty-nine Italian Lymphoma Foundation-affiliated institutions participated, and 504 questionnaires were sent out. Forty institutions (67.8%) returned 154 (30.5%) completed questionnaires. The largest majority (91.5%, 141/154) were aware of possible HBV reactivation as a consequence of immunosuppression. Most of the participants providing an answer (93.3%; 126/135) performed universal screening, and were aware of strategies for managing reactivation (96.4%, 132/137). Specialists treating lymphoma show a high level of awareness concerning the management of HBV reactivation under immunosuppression. However, uncertainties regarding the issue of HBV reactivation still emerge in this setting, and thus continuing collaborative effort between hepatologists and hematologists is necessary.
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Affiliation(s)
- Massimo Marignani
- Digestive and Liver Disease Department, School of Medicine and Psychology, University "Sapienza", Azienda Ospedaliera S. Andrea , Rome , Italy
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