Zhengzheng Xia, Jianyu Zhang, Wenjun Chen, Haiyan Zhou, Di Du, Kongcai Zhu, Hui Chen, Jun Meng, Jun Yang
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引用次数: 1
摘要
背景：免疫疗法有望成为各种癌症的治疗选择。然而，人们越来越担心检查点阻断免疫疗法后乙型肝炎病毒（HBV）再激活的潜在并发症。尽管以前大多数关于免疫检查点抑制剂（ICIs）的临床试验都排除了HBV患者，但已经发表了一些HBV再激活的病例报告和回顾性研究。本研究的目的是评估接受ICI治疗晚期癌症患者的乙型肝炎病毒再激活（HBVr）风险。方法：在PubMed、EMBASE、Web of Science、Cochrane、SinoMed、CNKI和Wanfang Data中检索2023年4月30日之前发表的中英文文献，以了解报道ICIs治疗的癌症患者HBVr率的研究。以95%置信区间（CI）计算HBVr发病率的合并风险估计值。结果：检索并分析了34项研究的数据，包括7126名患者。接受ICIs治疗的癌症患者的合并HBVr率为1.3%（I2 = 90.44%，95%置信区间：0.2-2.9%，P 结论：我们的荟萃分析表明，接受ICIs治疗的晚期癌症患者的HBVr风险较低。ICI治疗可以安全地用于已有HBV感染或慢性乙型肝炎的患者，并在必要时进行定期监测和适当的抗病毒预防。
Hepatitis B reactivation in cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis.
Background: Immunotherapy shows promise as a treatment option for various cancers. However, there is growing concern over potential complications from hepatitis B virus (HBV) reactivation after checkpoint blockade immunotherapy. Although most of the previous clinical trials on immune checkpoint inhibitors (ICIs) excluded patients with HBV, a few case reports and retrospective studies of HBV reactivation have been published. The aim of this study is to assess the risk of hepatitis B virus reactivation (HBVr) in patients receiving ICIs for advanced cancer.
Methods: English and Chinese language literature published prior to April 30, 2023, was searched in PubMed, EMBASE, Web of Science, Cochrane, SinoMed, CNKI and Wanfang Data for studies reporting HBVr rates in cancer patients treated with ICIs. A pooled risk estimate was calculated for HBVr rates with 95% confidence intervals (CI).
Results: Data from 34 studies including 7126 patients were retrieved and analyzed. The pooled HBVr rate in cancer patients treated with ICIs was 1.3% (I2 = 90.44%, 95% CI: 0.2-2.9%, P < 0.001). Subgroup analysis revealed that patients diagnosed with hepatocellular carcinoma (HCC), HBV carriers, and patients from Asian regions or in developing countries have a higher rate of HBVr.
Conclusions: Our meta-analysis demonstrated a low risk of HBVr in patients treated with ICIs for advanced cancer. ICI treatment may be safely used in patients with existing HBV infection or chronic hepatitis B, accompanied by regular monitoring and appropriate antiviral prophylaxis if necessary.
期刊介绍：
Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
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