American Gastroenterological Association Institute Technical Review on Prevention and Treatment of Hepatitis B Virus Reactivation During Immunosuppressive Drug Therapy

Perrillo, Robert P.; Gish, Robert G.; Falck‐Ytter, Yngve

doi:10.1053/j.gastro.2014.10.038

Cited by 448 publications

(609 citation statements)

References 98 publications

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“…In those patients with waning protective titers, it is reasonable to give a single booster shot, and if titers do not rise appropriately, consider administration of another 3 vaccination series at the regular dose. Prophylaxis regimens for patients at risk for HBV reactivation were recently reviewed ( 95,96 ). source but scored high on quality.…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

380

413

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

380

413

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“…As for the testing regimens of HBV, guidance from CDC, AGA, and AASLD recommend combination testing: HBsAg plus HBsAb and/or HBcAb to test patients prior to immunosuppressive therapy (13)(14)(15). In contrast, the ACR 2008 RA treatment guideline only recommended that evaluation might include HBsAg, HBsAb, or HBcAb in patients with hepatitis risk factors (e.g., injection drug use, sexually transmitted disease, or health-care professionals) (25), with no updates in the version published in 2015 (26).…”

Section: Discussionmentioning

confidence: 99%

“…The predefined combination tests are recommended by several guidelines (13)(14)(15). HBV testing rates were calculated as the annual number of RA patients who ever received tests divided by total RA patients in a year and compared between the US and Taiwan.…”

Section: Significance and Innovationsmentioning

confidence: 99%

“…The US Centers for Disease Control and Prevention (CDC), the European Association for the Study of the Liver, and the American Association for the Study of Liver Diseases (AASLD) recommend universal HBV testing in all patients scheduled for immunosuppressive therapy (12)(13)(14). In contrast, the American College of Rheumatology (ACR) and the American Gastroenterological Association (AGA) recommend risk-based testing limited to patients with HBV risk factors (15,16). Nevertheless, physicians' ability to identify risk factors for HBV (e.g., endemic region of origin or risky behaviors) was found suboptimal (17), suggesting that risk-based testing may not be effective.…”

Section: Introductionmentioning

confidence: 99%

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Practice Pattern of Hepatitis B Testing in Rheumatoid Arthritis Patients: A Cross‐National Comparison Between the US and Taiwan

Lin

Hashemi

Kim

et al. 2017

Arthritis Care & Research

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Objective. The hepatitis B virus (HBV) testing rates and patterns in rheumatoid arthritis (RA) patients starting disease-modifying antirheumatic drugs (DMARDs) have not been well studied. We describe and compare the practice patterns of HBV testing among RA patients in the US and Taiwan. Methods. We conducted a retrospective cohort study, including RA patients starting a first DMARD in the US or Taiwan. The first date patients newly received any DMARD was defined as the index date, and the 1-year period before the index date was the baseline period. HBV testing was defined as any of the following tests 1 year before or after the index date: hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, hepatitis B envelope antigen, hepatitis B envelope antibody, or HBV DNA. We calculated the HBV testing rate by year and used Poisson regression to calculate the testing rate ratio. Results. We identified 14,568 RA patients in the US and 46,265 in Taiwan. The overall testing rate was 20.3% in the US and 24.5% in Taiwan, and gradually increased over the study period from 13.1-23.0% in the US and 16.8-30.0% in Taiwan. More than one type of HBV test was used in 43.4% of patients in the US and 16.3% of patients in Taiwan receiving tests. Results of Poisson regression found Taiwan had a 17% higher testing rate over the US during the followup period (crude rate ratio 1.17 [95% confidence interval 1.12-1.22]). Conclusion. We found small differences in the HBV testing rates across the US and Taiwan. Although the rate gradually increased in the past decade, it remained low in both countries.

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“…Az immunszuppresszív kezelésben, illetve biológiai terápiában részesülő betegek esetében a kockázatokat és a teendőket táblázatban is összefoglaltuk (6. és 7. táblázat) [23][24][25]. …”

Section: Kezelésunclassified

A hepatitis B- és D-vírus-fertőzés diagnosztikája, antivirális kezelése. Magyar konszenzusajánlás. Érvényes: 2017. szeptember 22-től

et al. 2018

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A hepatitis B-vírus-(HBV-) és a hepatitis D-vírus-fertőzés időben történő felfedezése és kezelése a beteg szempontjából a munkaképesség megőrzését, az életminőség javulását, a rákmegelőzést, valamint a betegségmentes várható élettartam meghosszabbodását, a beteg környezete és a társadalom szempontjából a továbbfertőzés veszélyének megállítását és a kezelés révén a későbbi súlyos májbetegségekből adódó jelentős egészségügyi ráfordításigény-csökkenést jelenti. Az irányelv célja a 2017. szeptember 22-től érvényes, a kezelőorvosok konszenzusán alapuló kezelési rend rögzítése. A magyar lakosság 0,5-0,7%-át sújtó HBV kezelésének indikációja a vírusdiagnosztikán (benne vírusnuk-leinsav kimutatása), a májbetegség aktivitásának és stádiumának értékelésén (beleértve a biokémiai, patológiai és/ vagy nem invazív vizsgálómódszereket), valamint az ellenjavallatok kizárásán alapul. Az ajánlás hangsúlyozza a kivizsgálás során a gyors és részletes virológiai vizsgálatok jelentőségét, a biopszia mellett a tranziens elasztográfia, illetve egyéb, validált, noninvazív tesztek alkalmazhatóságát csakúgy, mint a terápia vezetésében a vírusnukleinsav-titer kö-vetésének nélkülözhetetlenségét mind a mellékhatások elkerülése, mind a költséghatékonyság szempontjából. Az idült HBV-fertőzés kezelésében egyaránt első választás lehet a határozott -48 hetes -időtartamú pegiláltinterferon-vagy a folyamatos entecavir-vagy tenofovirkezelés, melyet a hepatitis B-felszíni antigén szerokonverziója után még legalább 12 hónapig kell folytatni. Nem megfelelő első választás a lamivudin, az ezt már szedő betegeket hatástalan-ság esetén másik szerre kell átállítani. Fontos az immunszuppresszív kezelésben és/vagy biológiai terápiában részesü-lő betegek megfelelő antivirális kezelése. Egyidejű hepatitis D-vírus-fertőzés esetén pegiláltinterferon-kezelés szüksé-ges. Orv Hetil. 2018; 159(Suppl 1): 24-37.

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American Gastroenterological Association Institute Technical Review on Prevention and Treatment of Hepatitis B Virus Reactivation During Immunosuppressive Drug Therapy

Cited by 448 publications

References 98 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Practice Pattern of Hepatitis B Testing in Rheumatoid Arthritis Patients: A Cross‐National Comparison Between the US and Taiwan

A hepatitis B- és D-vírus-fertőzés diagnosztikája, antivirális kezelése. Magyar konszenzusajánlás. Érvényes: 2017. szeptember 22-től

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