Hepatitis reactivation in patients with rheumatic diseases after immunosuppressive therapy—a report of long-term follow-up of serial cases and literature review

Xuan, Dong; Yu, Yiqi; Shao, Linyun; Wang, Jiali; Zhang, Wenhong; Zou, Hejian

doi:10.1007/s10067-013-2450-9

Cited by 39 publications

(40 citation statements)

References 41 publications

(40 reference statements)

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“…Similar to those using corticosteroids, reports of HBVr among patients with ARDs receiving IMD monotherapy are scarce, as the majority of them also received corticosteroids [28]. A recent prospective study found that the HBVr occurred in four of 211 (1.89%) patients with RA who were HBsAgþ or HBsAgÀ/anti-HBcþ and received cDMARD therapy without antiviral prophylaxis.…”

Section: Conventional Immunosuppressive Agentsmentioning

confidence: 94%

“…The reactivation occurred between 1 and 15 months post cDMARD administration [8]. A recent review found a prevalence of HBVr in 10 of 224 (4.46%) patients with rheumatic disease being treated with cDMARDs, eight of whom were given methotrexate (MTX) [28]. Another study of HBVr was performed in 288 patients with SLE receiving corticosteroids and cIMDs.…”

Section: Conventional Immunosuppressive Agentsmentioning

confidence: 98%

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Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

Louthrenoo

2015

Best Practice & Research Clinical Rheumatology

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Section: Conventional Immunosuppressive Agentsmentioning

confidence: 94%

Section: Conventional Immunosuppressive Agentsmentioning

confidence: 98%

Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

Louthrenoo

2015

Best Practice & Research Clinical Rheumatology

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“…In a prospective study of patients treated for nonHodgkin's lymphoma, lamivudine therapy started when ALT elevation was detected did not change the natural course of HBVr; 2 patients in this cohort died despite lamivudine use at the onset of HBVr [8] . Numerous case reports and series describe death due to liver failure despite the introduction of lamivudine at the onset of HBVr [82][83][84][85][86] . Only a few cases of successful treatment of HBVr with entecavir have been published [87][88][89] .…”

Section: Management Of Hbvrmentioning

confidence: 99%

Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

Pattullo

2015

WJH

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in the setting of chemotherapy and immunosuppression may lead to fulminant liver failure and death, but there is a cumulative body of evidence that these are potentially preventable adverse outcomes. As chronic hepatitis B is largely asymptomatic but also endemic worldwide, clinicians caring for patients requiring chemotherapy or immunosuppression need to be vigilant of the potential for HBVr in susceptible individuals. Serological screening and prophylactic and pre-emptive antiviral treatment with a nucleos(t)ide analogue should be considered in appropriate settings. Hepatitis B prevalence is examined in this review article, as are the risks of HBVr in patients receiving chemo-and immunosuppressive therapy. Recommendations regarding screening, monitoring and the role of antiviral prophylaxis are outlined with reference to current international associations' guidelines and the best available evidence to date. AbstractDue to the inherent relationship between the immune system and the hepatitis B virus (HBV) in exposed and infected individuals, immunomodulation associated with the treatment of solid tumours, haematological malignancies and inflammatory disorders has been linked to HBV reactivation (HBVr). Reactivation of HBV infection REVIEWSubmit a

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“…Finally, Xuan et al [63] have reviewed 30 cases of reactivation after steroids, in monotherapy or combined with other therapies, in 144 patients with rheumatic diseases. The mean time to reactivations was 9.8 mo.…”

Section: Hbv Reactivations In Patients With Inflammatory Diseasesmentioning

confidence: 99%

“…Adapted from Xuan et al [63] . CHB: Chronic hepatitis B, inactive carriers included; RS: Resolved infection; HBV: Hepatitis B virus.…”

Section: Hbv Reactivations (N )mentioning

confidence: 99%

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

López-Serrano

Briongos

Alonso

et al. 2015

WJH

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Currently immunosuppressive and biological agents are used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus (HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to preemptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapyCore tip: Few reviews have been published including data of the three more common inflammatory diseases that require immunosuppressive therapy: inflammatory bowel disease, rheumatic and dermatologic diseases. This paper is focused on the risk of reactivation of hepatitis B virus under immunosuppressants, and particularly corticosteroids. Although most of the guidelines do not specify the necessity of prophylaxis in case of monotherapy with corticosteroids, the specialists responsible of these patients are usually concerned about this issue. Moreover, the risk with low systemic bioavailability new corticosteroids has not been evaluated in previous reviews. This work summarizes the evidence of VHB reactivation in patients with inflammatory diseases: when and how to apply prophylaxis, with a special focus on "new" and "old" steroids.López-Serrano P, de la Fuente Briongos E, Carrera-Alonso E, Pérez-Calle JL, Fernández Rodríguez C. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy.

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Hepatitis reactivation in patients with rheumatic diseases after immunosuppressive therapy—a report of long-term follow-up of serial cases and literature review

Cited by 39 publications

References 41 publications

Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

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