Hepatitis B virus reactivation in patients treated with immunosuppressive drugs: a practical guide for clinicians

Koffas, Apostolos; Dolman, Grace; Kennedy, Patrick

doi:10.7861/clinmedicine.18-3-212

Cited by 31 publications

(34 citation statements)

References 38 publications

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“…B-cell depleting therapies (e.g. RTX) are associated with possible reactivation of a hepatitis B infection, therefore antiviral prophylaxis is advised [87]. Before splenectomy, vaccinations against Haemophilus influenzae, Meningococcus and Pneumoccoccus species are recommended [9].…”

Section: Aiha Treatmentmentioning

confidence: 99%

Autoimmune hemolytic anemia: current knowledge and perspectives

et al. 2020

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Autoimmune hemolytic anemia (AIHA) is an acquired, heterogeneous group of diseases which includes warm AIHA, cold agglutinin disease (CAD), mixed AIHA, paroxysmal cold hemoglobinuria and atypical AIHA. Currently CAD is defined as a chronic, clonal lymphoproliferative disorder, while the presence of cold agglutinins underlying other diseases is known as cold agglutinin syndrome. AIHA is mediated by autoantibodies directed against red blood cells (RBCs) causing premature erythrocyte destruction. The pathogenesis of AIHA is complex and still not fully understood. Recent studies indicate the involvement of T and B cell dysregulation, reduced CD4+ and CD25+ Tregs, increased clonal expansions of CD8 + T cells, imbalance of Th17/Tregs and Tfh/Tfr, and impaired lymphocyte apoptosis. Changes in some RBC membrane structures, under the influence of mechanical stimuli or oxidative stress, may promote autohemolysis. The clinical presentation and treatment of AIHA are influenced by many factors, including the type of AIHA, degree of hemolysis, underlying diseases, presence of concomitant comorbidities, bone marrow compensatory abilities and the presence of fibrosis and dyserthropoiesis. The main treatment for AIHA is based on the inhibition of autoantibody production by mono- or combination therapy using GKS and/or rituximab and, rarely, immunosuppressive drugs or immunomodulators. Reduction of erythrocyte destruction via splenectomy is currently the third line of treatment for warm AIHA. Supportive treatment including vitamin supplementation, recombinant erythropoietin, thrombosis prophylaxis and the prevention and treatment of infections is essential. New groups of drugs that inhibit immune responses at various levels are being developed intensively, including inhibition of antibody-mediated RBCs phagocytosis, inhibition of B cell and plasma cell frequency and activity, inhibition of IgG recycling, immunomodulation of T lymphocytes function, and complement cascade inhibition. Recent studies have brought about changes in classification and progress in understanding the pathogenesis and treatment of AIHA, although there are still many issues to be resolved, particularly concerning the impact of age-associated changes to immunity.

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Section: Aiha Treatmentmentioning

confidence: 99%

Autoimmune hemolytic anemia: current knowledge and perspectives

et al. 2020

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“…HBsAg‐negative and anti‐HBc‐positive patients receiving immunosuppressive agents and anti‐tumour chemotherapy are at risk of HBV reactivation . Levels of ALT, HBV DNA and HBsAg should be assessed before initiating such treatments and be closely monitored during and post‐treatments.…”

Section: Long‐term Follow‐up and Monitoringmentioning

confidence: 99%

Roadmap to functional cure of chronic hepatitis B: An expert consensus

Ning

Wang

Ren

et al. 2019

Journal of Viral Hepatitis

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Hepatitis B virus (HBV) infection continues to be a major public health issue worldwide. HBsAg loss is associated with functional remission and improved long-term outcome, and is considered to be a 'functional cure' (also referred to as clinical or immunologic cure) for chronic hepatitis B. This ideal goal of therapy can be achieved using optimized combination regimens with direct-acting antivirals [eg nucleos(t)ide analogues (NAs)] and immunomodulators [eg pegylated interferon alpha2a (Peg-IFN)] in selected patients with chronic hepatitis B. Among different combination therapies currently available, those with NA lead-in followed by Peg-IFN in virally suppressed patients has been demonstrated to be effective. This review provides an updated overview of the evidence supporting the use of combination therapies and summarizes expert consensus on the roadmap to attain functional cure for chronic hepatitis B patients. K E Y W O R D S chronic hepatitis B, combination therapy, consensus, functional cure, HBsAg loss | 1147 NING et al.

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“…Second, the treatment factors can be divided into high risk, moderate risk, and low risk [30,31,32]. The several risk factors of treatment of HBV reactivation are solid organ or hematopoietic stem cell transplantation and the administration of rituximab, antitumor necrosis factor-α (TNF-α) agents, steroids, and anthracycline [13,15,33,34,35,36,37].…”

Section: Hbv Reactivationmentioning

confidence: 99%

“…The risk classification of treatments and drugs in MM is summarized in Table 2. Histone deacetylase inhibitors are classified into moderate risk groups [31,32]. However, we classified panobinostat usually combined with bortezomib for MM patients into the unclassifiable group, because there were no reports on panobinostat and HBV reactivation.…”

Section: Hbv Reactivationmentioning

confidence: 99%

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Reactivation of Hepatitis B Virus in Patients with Multiple Myeloma

Tsukune

Sasaki

Komatsu

2019

Cancers

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Reactivation of hepatitis B virus (HBV) is a well-known complication in patients with hematological malignancies during or after cytotoxic chemotherapy. If the initiation of antiviral therapy is delayed in patients with HBV reactivation, these patients can develop severe hepatitis and may die of fulminant hepatitis. The preventive strategy for HBV reactivation in patients with malignant lymphoma has already been established based on some prospective studies. As there was an increased number of novel agents being approved for the treatment of multiple myeloma (MM), the number of reported cases of HBV reactivation among MM patients has gradually increased. We conducted a Japanese nationwide retrospective study and revealed that HBV reactivation in MM patients is not rare and that autologous stem cell transplantation is a significant risk factor. In this study, around 20% of all patients with HBV reactivation developed HBV reactivation after 2 years from the initiation of therapy, unlike malignant lymphoma. This might be due to the fact that almost all of the patients received chemotherapy for a long duration. Therefore, a new strategy for the prevention of HBV reactivation in MM patients is required.

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Hepatitis B virus reactivation in patients treated with immunosuppressive drugs: a practical guide for clinicians

Abstract: how a robust multidisciplinary service can be delivered to prevent HBVr in UK clinical practice through optimisation of resources and introduction of checkpoints to prevent the inappropriate administration of immunosuppression to those at signifi cant risk of HBVr.

Cited by 31 publications

References 38 publications

Autoimmune hemolytic anemia: current knowledge and perspectives

Autoimmune hemolytic anemia: current knowledge and perspectives

Roadmap to functional cure of chronic hepatitis B: An expert consensus

Reactivation of Hepatitis B Virus in Patients with Multiple Myeloma

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