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 Jung

doi:10.1007/s15010-019-01271-z

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

Infection. 2019 Apr;47(2):293-300. doi: 10.1007/s15010-019-01271-z. Epub 2019 Jan 28.

Authors

Linda Drößler¹, Clara Lehmann^{1

2

3}, Karin Töpelt¹, Dirk Nierhoff⁴, Jörg J Vehreschild^{1

2}, Jan Rybniker^{1

2

3}, Michael Hallek¹, Julia Fischer¹, Verena Stormberg⁵, Gerd Fätkenheuer^{1

2}, Ulrike Wieland⁶, Norma Jung⁷

Affiliations

¹ Department I of Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
² German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
³ Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
⁴ Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany.
⁵ Institute of Pharmacy, University of Cologne, Cologne, Germany.
⁶ Institute of Virology, University of Cologne, Cologne, Germany.
⁷ Department I of Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. norma.jung@uk-koeln.de.

PMID: 30689161
DOI: 10.1007/s15010-019-01271-z

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: Autoimmune diseases; Hematologic diseases; Hepatitis B; Monotherapy; Reactivation; Risk groups; Rituximab.

MeSH terms

Adult
Aged
Antirheumatic Agents / therapeutic use*
Cohort Studies
Drug Therapy, Combination
Female
Germany
Hepatitis B / drug therapy*
Hepatitis B / virology
Hepatitis B Core Antigens / immunology
Hepatitis B Surface Antigens / immunology
Hepatitis B virus / drug effects*
Hepatitis B virus / physiology
Humans
Male
Middle Aged
Retrospective Studies
Rituximab / therapeutic use*
Virus Activation / drug effects*

Substances

Antirheumatic Agents
Hepatitis B Core Antigens
Hepatitis B Surface Antigens
Rituximab