Rituximab carries high risks of hepatitis B virus reactivation in hematologic and rheumatic patients with chronic or resolved hepatitis B.

IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Kuan-Chu Hou, Tung-Hung Su, Chien-Neng Kao, Huei-Ru Cheng, Tai-Chung Tseng, Chun-Jen Liu, Song-Chou Hsieh, Jia-Horng Kao
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Abstract

Background and aim: Rituximab therapy is associated with a high risk of hepatitis B virus (HBV) reactivation. We aimed to assess whether the risk of reactivation differed among various underlying diseases and between hepatitis B surface antigen (HBsAg) carriers and patients with resolved HBV infection.

Methods: We retrospectively analyzed patients with chronic or resolved HBV infection who received rituximab without prophylactic anti-HBV therapy at a tertiary medical center. The risks of HBV reactivation, hepatitis, and hepatic decompensation were compared between the patients with hematologic and rheumatic diseases.

Results: There were 78 patients with hematologic diseases and 39 patients with rheumatic diseases included. Among them, 43 (59%) HBsAg-positive patients and 24 (55%) patients with resolved HBV infection experienced HBV reactivation at a median of 14.6 months after rituximab therapy. After rituximab treatment, the 1-year HBV reactivation rate among patients with hematologic and rheumatic diseases was 29% and 45% in HBsAg-positive patients, respectively, while the rates were 38% and 17% in patients with resolved HBV infection. The reactivation risk continued to increase even 2 years after rituximab therapy and was comparable between hematologic and rheumatic patients. A higher baseline HBV DNA level (≥20 IU/mL vs <20 IU/mL) was an independent predictor for HBV reactivation (adjusted hazard ratio [aHR]: 10.9, 95% confidence interval [CI]: 1.1-107) and HBV-associated hepatitis (aHR: 14.8, 95% CI: 1.4-158).

Conclusions: Rituximab therapy is associated with a 50-64% risk of HBV reactivation regardless of underlying diseases and HBsAg status. HBV DNA levels should be assessed before initiating rituximab.

利妥昔单抗对患有慢性或已治愈乙型肝炎的血液病和风湿病患者具有乙型肝炎病毒再激活的高风险。
背景和目的:利妥昔单抗治疗与乙型肝炎病毒(HBV)再激活的高风险相关。我们旨在评估各种基础疾病之间以及乙型肝炎表面抗原(HBsAg)携带者和已治愈的 HBV 感染者之间的再激活风险是否存在差异:我们对一家三级医疗中心接受利妥昔单抗治疗但未进行预防性抗 HBV 治疗的慢性或已治愈 HBV 感染患者进行了回顾性分析。比较了血液病和风湿病患者发生 HBV 再激活、肝炎和肝功能失代偿的风险:结果:共纳入 78 名血液病患者和 39 名风湿病患者。其中,43 例(59%)HBsAg 阳性患者和 24 例(55%)HBV 感染缓解的患者在利妥昔单抗治疗后中位 14.6 个月出现 HBV 再激活。接受利妥昔单抗治疗后,血液病和风湿病患者中 HBsAg 阳性患者 1 年的 HBV 再激活率分别为 29% 和 45%,而 HBV 感染缓解患者的再激活率分别为 38% 和 17%。即使在利妥昔单抗治疗 2 年后,重新激活的风险仍在增加,血液病患者和风湿病患者的重新激活风险相当。基线HBV DNA水平较高(≥20 IU/mL vs 结论:利妥昔单抗治疗与HBV再激活相关:无论基础疾病和 HBsAg 状态如何,利妥昔单抗治疗都会导致 50-64% 的 HBV 再激活风险。在开始利妥昔单抗治疗前应评估 HBV DNA 水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.90
自引率
2.40%
发文量
326
审稿时长
2.3 months
期刊介绍: Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.
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