Nucleos(t)ide analogues for preventing HBV reactivation in immunosuppressed patients with hematological malignancies: a network meta-analysis

Zhang, Minyue; Zhu, Gui‐Qi; Zheng, Ji-Na; Zhang, Cheng; Poucke, Sven Van; Shi, Ke‐Qing; Huang, Honghui; Chen, Fangyuan; Zheng, Ming‐Hua

doi:10.1080/14787210.2017.1309291

Cited by 16 publications

(9 citation statements)

References 35 publications

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“…According to the guidelines for the management of HBV infection, HBV incipient screening and antiviral therapy are recommended to prevent HBV reactivation for patients receiving anti-cancer therapy, especially rituximab or hematopoietic stem cell transplantation. [ 25 , 26 ] In our study, 94% were tested early among the hematologic malignancy patients who had HBV testing. However, among the 153 patients with chronic HBV, only 40% had early antiviral therapy, likely because of less dynamic monitoring and antiviral therapy in a timely manner.…”

Section: Discussionmentioning

confidence: 96%

The association of hepatitis B virus screening and antiviral prophylaxis with adverse liver outcomes in Chinese cancer patients undergoing chemotherapy

Wang²,

et al. 2020

Medicine

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Currently, the association of the initiation time of hepatitis B virus (HBV) screening and antiviral prophylaxis with adverse liver outcomes in cancer patients undergoing chemotherapy remains conflicting. This retrospective study was designed to determine the association of HBV screening and antiviral prophylaxis with adverse liver outcomes, and then proposed optimal management strategies on HBV screening and antiviral prophylaxis. We analyzed the medical data of Chinese cancer patients undergoing chemotherapy between 2000 and 2015. Descriptive statistics and Chi square tests were performed to analyze the basic characteristics of patients. Time-to-event analysis was used to determine incidence, and competing risk analysis was used to determine the hazard ratios (HRs) for outcomes. A total of 12,158 patients (81.1% with solid tumors) were analyzed. Among solid tumors patients, late screening and late antiviral therapy of chronic HBV were associated with higher incidence of hepatitis flare (HR 3.29, 95% confidence interval [CI] 2.26–4.79; HR 6.79, 95% CI 4.42–10.41), hepatic impairment (HR 2.96, 95% CI 2.03–4.32; HR 8.03, 95% CI 4.78–13.48), liver failure (HR 2.19, 95% CI 1.41–3.40; HR 14.81, 95% CI 6.57–33.42), and HBV-related death (HR 3.29, 95% CI 2.26–4.79; HR 8.30, 95% CI 4.95–13.91) in comparison with early screening and early therapy. Early HBV screening and antiviral therapy could reduce the risk of adverse liver outcomes among chronic HBV patients receiving chemotherapy. Hepatitis B surface antibody-positivity was associated with a decreased risk of liver failure and chronic HBV, late screening or late antiviral therapy were predictors of liver failure for patients with anti-tumor therapy. However, it should be applied cautiously into each types of solid tumors and hematologic malignancies because subgroup analysis according to type of cancer was not designed.

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Section: Discussionmentioning

confidence: 96%

The association of hepatitis B virus screening and antiviral prophylaxis with adverse liver outcomes in Chinese cancer patients undergoing chemotherapy

Wang²,

et al. 2020

Medicine

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“…4 The present study found that several antitumor treatments, including TACE, RFA, MWA, PEI, and brachytherapy, were associated with HBV reactivation, which is associated with recurrence of HCC and OS, consistent with previous reports. [19][20][21][22][23] Combining antiviral treatment with conventional antitumor therapy is significantly associated with a reduced HBV reactivation. 24,25 When treating liver cancer (eg, by TACE), some patients developed hepatitis B flares, and their risk was reduced by the use of antiviral drugs.…”

Section: Discussionmentioning

confidence: 99%

Association of Hepatitis B Virus DNA Level and Follow-up Interval With Hepatocellular Carcinoma Recurrence

et al. 2020

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IMPORTANCE Antiviral treatment is important in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) comprehensive therapy. A high HBV DNA level is an independent risk factor for HBV-related HCC, but no quantifiable clinical index is available to date. OBJECTIVE To evaluate the feasibility and availability of the novel HBV DNA quantitation-time index (HDQTI), which includes HBV DNA quantitation and follow-up, to predict HBV-related HCC prognosis. DESIGN, SETTING, AND PARTICIPANTS This retrospective prognostic study of patients with HCC from multiple centers in China was performed from January 1, 2002, to December 31, 2016. The median follow-up time was 18 months, and the longest follow-up time was 147 months. Data analysis was performed from January 1, 2017, to December 31, 2018. MAIN OUTCOMES AND MEASURES Clinical characteristics, antitumor management, antiviral treatment, HDQTI scores, follow-up information, and overall survival were recorded and analyzed. A receiver operating characteristic curve and accompanying area under the curve were calculated for HDQTI. RESULTS A total of 842 patients (mean [SD] age, 61.80 [9.85] years; 513 [60.9%] male) were included in the study. Of all included patients, 734 received no antiviral therapy before diagnosis (no previous diagnosis of HBV infection), 43 underwent nonstandard antiviral therapy, and 65 received regular antiviral therapy. Compared with the group without antiviral treatment, the Barcelona Clinic Liver Cancer (BCLC) stage was earlier (A:B:C, 73.8%:26.2%:0% to 5.7%:65.5%:28.8%, P < .001), the mean (SD) tumor size was smaller (2.89 [1.26] to 7.56 [3.28] cm, P < .001), the ratio of baseline HBV DNA level of more than 10 5 copies/mL was lower (10.8% to 40.6%, P < .001), and the ratio of the α 1-fetoprotein level more than 400 ng/mL was less (21.5% to 78.2%, P < .001) in the standard antiviral treatment group, whereas the nonstandard treatment group was between the 2 groups. Recurrence occurred in 39 of 109 BCLC stage A cases. Patients with HDQTI scores higher than 34 had high risk of recurrence; at this cutoff level, the sensitivity of the HDQTI was 76.9% and the specificity was 92.9%, with an area under curve of 0.928. Patients in various BCLC stages had similar trends in overall survival and HDQTI scores (BCLC stage A: HDQTI score <34, not applicable; HDQTI score Ն34,

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“…In patients undergoing chemotherapy for various hematological malignancies, the reported incidence of HBVr is 32.08% to 60%. 30,31 The network meta-analysis by Zhang et al 10 compared the use of five antivirals for prophylaxis of HBVr in immunosuppressed patients with hematological malignancies and found superior efficacy for ETV (88%) and TDF (90%) when compared to LAM, ADV and TBV. Our meta-analysis focused on efficacy of HBVr prophylaxis specifically among allo-HSCT patients and analyzed data from ten studies in which 611 HR patients received prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Reference lists of, and citations to the articles eventually selected from the database searches, were also screened, as was the reference list of a related, recently published review. 10…”

Section: Methodsmentioning

confidence: 99%

Prophylaxis for Hepatitis B Virus Reactivation after Allogeneic Stem Cell Transplantation in the Era of Drug Resistance and Newer Antivirals: A Systematic Review and Meta-Analysis

Siyahian

Malik

Mushtaq

et al. 2018

Biology of Blood and Marrow Transplantation

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Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are at a very high risk of hepatitis B virus reactivation (HBVr). Lamivudine is commonly used as prophylaxis against HBVr in high-risk patients undergoing allo-HSCT. Unfortunately, its efficacy is diminishing due to the development of HBV mutant drug-resistant strains. With the availability of newer antiviral agents such as entecavir, telbivudine, adefovir, and tenofovir, it is important to assess their role in HBVr prophylaxis. A comprehensive search of 7 databases was performed to evaluate efficacy of antiviral prophylaxis against HBVr in allo-HSCT patients (PubMed/Medline, Embase, Scopus, Cochrane Library, Web of Science, CINAHL, and ClinicalTrials.gov (June 21, 2017)). We identified 10 studies, with 2067 patients undergoing allo-HSCT; these primarily evaluated the use of lamivudine and entecavir as prophylaxis against HBVr in patients undergoing allo-HSCT because there were little or no data about adefovir, telbivudine, or tenofovir as prophylaxis in this specific patient population. Thus, included studies were categorized into 2 main prophylaxis groups: lamivudine and entecavir. Results of our meta-analysis suggest that entecavir is very effective against HBVr, although further clinical trials are required to test efficacy of new antivirals and explore the emerging threat of drug resistance.

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Nucleos(t)ide analogues for preventing HBV reactivation in immunosuppressed patients with hematological malignancies: a network meta-analysis

Abstract: Tenofovir and entecavir might be the most potent regimes in prevention of HBV reactivation for CHB infected patients with hematological malignancies undergoing chemotherapy or HSCT.

Cited by 16 publications

References 35 publications

The association of hepatitis B virus screening and antiviral prophylaxis with adverse liver outcomes in Chinese cancer patients undergoing chemotherapy

The association of hepatitis B virus screening and antiviral prophylaxis with adverse liver outcomes in Chinese cancer patients undergoing chemotherapy

Association of Hepatitis B Virus DNA Level and Follow-up Interval With Hepatocellular Carcinoma Recurrence

Prophylaxis for Hepatitis B Virus Reactivation after Allogeneic Stem Cell Transplantation in the Era of Drug Resistance and Newer Antivirals: A Systematic Review and Meta-Analysis

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