Antiviral treatment including entecavir plus tenofovir disoproxil fumarate for HBV reactivation following a rituximab-based regimen

Abstract

Entecavir and tenofovir disoproxil fumarate are potent and effective antiviral drugs that now represent recommended treatment options for chronic HBV infection. However, no or very limited clinical evidence is currently available on these drugs for the management of HBV reactivation in patients with haematological malignancies. Herein, we report a case of HBV reactivation in a patient with non-Hodgkin's lymphoma following a rituximab-based regimen, and who was successfully treated with a combination antiviral treatment including entecavir and tenofovir disoproxil fumarate.

Late onset of hepatitis B virus reactivation following hematopoietic stem cell transplantation: successful treatment with combined entecavir plus tenofovir therapy

“…The present case is, to our knowledge, the first report of a successful treatment of HBV‐R in an HSCT recipient by the use of combination therapy with entecavir plus tenofovir. In another recently published case report of combination therapy, the treatment regimen was sequential, with tenofovir added to entecavir after 6 months of monotherapy (18).…”

“…The present case is, to our knowledge, the ¢rst report of a successful treatment of HBV-R in an HSCT recipient by the use of combination therapy with entecavir plus tenofovir. In another recently published case report of combination therapy, the treatment regimen was sequential, with tenofovir added to entecavir after 6 months of monotherapy (18). Although mutations within HBsAg have been frequently described in HBsAg-negative patients presenting HBV-R (8,19), at the time of HBV-R, neither mutations associated with altered antigencity of the s protein, nor with LAM resistance could be detected.…”

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

“…We were able to retrieve only a few reports on the use of Tenofovir (TFV), the other currently available third generation NUC also provided with a high potency and genetic barrier, in the setting of HBV reactivation in HM patients [67,68] . In these reports, TFV was, however, used in combination with ETV.…”

Management of severe acute to fulminant hepatitis B: to treat or not to treat or when to treat?

“…On the contrary, more data concerning the two newer antivirals entecavir and tenofovir has been published in cases with severe acute reactivation of chronic or occult HBV infection after immunosuppression or chemotherapy, a situation which is similar enough with that of the "naïve" acute severe to fulminant hepatitis B (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). In these studies the treatment was started as rescue therapy after exacerbation of chronic or occult hepatitis B and particularly in those who had received rituximab-based regimen, with favourable outcome in most of the affected cases (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). It should be noted, however, that not all of these patients with HBV reactivation suffered from severe hepatic failure as defined above (38)(39)(40), while several difficulties of managing severe HBV reactivation are still present (e.g.…”

“…The most solid data are indeed published for lamivudine whereas the same level of evidence to demonstrate safety in severe acute hepatitis B is not yet available for entecavir or tenofovir as these newer more potent antivirals have become available more recently. However, existing evidence shows that entecavir and tenofovir are efficient in a similar situations as the acute, severe reactivation of overt or occult HBV infection (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78), but still toxicity with entecavir or tenofovir cannot be excluded at the same level of certainty (81,82). Overall, we can suggest that lamivudine or the more potent antivirals could be used by the hepatologists if they must treat cases with severe acute hepatitis B.…”