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

Marignani, Massimo

doi:10.4251/wjgo.v4.i3.37

Cited by 8 publications

(7 citation statements)

References 74 publications

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“…The prevalence of anti‐HBc positivity is related to the prevalence of HBV infection in the general population and is low in most Western countries (about 7%), although it appears to increase with age . In our 1218 rheumatologic patients we found anti‐HBc positivity in 216 (17.7%), a similar value to the one observed in Italian patients with oncohematological disease with a prHBV infection (18.8%) …”

Section: Discussionsupporting

confidence: 71%

Safety of long‐term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection

et al. 2015

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European and Asian studies report conflicting data on the risk of hepatitis B virus (HBV) reactivation in rheumatologic patients with a previously resolved HBV (prHBV) infection undergoing long-term biologic therapies. In this patient category, the safety of different immunosuppressive biologic therapies, including rituximab, was assessed. A total of 1218 Caucasian rheumatologic patients, admitted consecutively as outpatients between 2001 and 2012 and taking biologic therapies, underwent evaluation of anti-HCV and HBV markers as well as liver amino transferases every 3 months. Starting from January 2009, HBV DNA monitoring was performed in patients with a prHBV infection who had started immunosuppressive biologic therapy both before and after 2009. Patients were considered to have elevated aminotransferase levels if values were >1× upper normal limit at least once during follow-up. We found 179 patients with a prHBV infection (14 treated with rituximab, 146 with anti-tumor necrosis factor-alpha, and 19 with other biologic therapies) and 959 patients without a prHBV infection or other liver disease (controls). The mean age in the former group was significantly higher than the controls. Patients with a prHBV infection never showed detectable HBV DNA serum levels or antibody to hepatitis B surface antigen/hepatitis B surface antigen seroreversion. However, when the prevalence of elevated amino transferases in patients with prHBV infection was compared to controls, it was significantly higher in the former group only for aminotransferase levels >1× upper normal limit but not when aminotransferase levels >2× upper normal limit were considered. Conclusion: Among patients with a prHBV infection and rheumatologic indications for long-term biologic therapies, HBV reactivation was not seen; this suggests that universal prophylaxis is not justified and is not cost-effective in this clinical setting. (Hepatology 2015)

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Section: Discussionsupporting

confidence: 71%

Safety of long‐term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection

et al. 2015

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“…Reactivation of HBV, even in occult carriers, is one of the emerging problems in RA patients undergoing immunosuppressive treatment, especially with old and newer bDMARDs . There have been reports about HBV reactivation in patients with a history of occult HBV infection (i.e., negative for HBsAg but positive for antibody anti‐HBc and/or antibody to HBsAg) receiving immunosuppressive therapy and/or chemotherapy for autoimmune diseases, organ transplantation, or malignancy .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of rheumatoid arthritis (RA) patients with concomitant HBV is a clinical challenge. Conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) could be associated with increased hepatotoxicity, and biologic DMARDs (bDMARDs), in particular tumor necrosis factor (TNF) blockers and anti‐CD20 monoclonal antibodies, as well as newer drugs like tocilizumab and abatacept, should be closely monitored for the possible reactivation of B hepatitis . Abatacept is a soluble fusion protein of the extracellular domain of CTLA‐4 and the Fc portion of IgG1 .…”

Section: Introductionmentioning

confidence: 99%

Safety of Abatacept in Rheumatoid Arthritis With Serologic Evidence of Past or Present Hepatitis B Virus Infection

Padovan

Filippini

Tincani

et al. 2016

Arthritis Care & Research

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Objective. Rheumatoid arthritis (RA) with concomitant hepatitis B virus (HBV) infection represents a therapeutic challenge due to the risk of HBV reactivation under immunosuppressive treatment. To date there are few data coming from anecdotal case reports that concern HBV reactivation following treatment with abatacept. This observational retrospective study was aimed to assess the safety profile of abatacept in this particular clinical setting. Methods. Eleven Italian rheumatologic centers provided data from patients with RA and positive HBV serology treated with intravenous abatacept. HBV markers and clinical and laboratory data were checked at followup visits every 3 months. Results. In total, 72 patients were included in the study: 47 inactive carriers, 21 occult carriers, and 4 chronic active carriers for HBV. At baseline all of the patients had normal liver function tests and low or undetectable HBV DNA levels, except for those with chronic active hepatitis. Thirteen patients received prophylaxis with lamivudine, and 4 received treatment with adefovir or tenofovir. At the end of the 24-month followup period, 49 patients were being treated. Data from 316 followup visits showed that abatacept was safe. No patients experienced reactivation of hepatitis B. Treatment withdrawals (23 patients) were due to lack of efficacy, subject decision/lost at followup, or adverse events not related to HBV infection. Conclusion. Our study provides reassuring data about the safety profile of abatacept in RA with concomitant HBV infection without universal antiviral prophylaxis. Further prospective studies are needed to confirm these preliminary results.

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“…Given the limited knowledge of HBV prevalence among HM in western world patients, considering that the available data mostly come from the treatment of lymphomas [49,50], even the use of screening might be insufficient. A screening procedure should be aimed at a selected population at higher risk of developing a disease condition, based on the prevalence of that condition in the population or in a selected group.…”

Section: Considerations On the Issue Of Hbv Testing Among Patientsmentioning

confidence: 99%

Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management

Zannella

Marignani

Begini

2019

Viruses

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It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.

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

Cited by 8 publications

References 74 publications

Safety of long‐term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection

Safety of long‐term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection

Safety of Abatacept in Rheumatoid Arthritis With Serologic Evidence of Past or Present Hepatitis B Virus Infection

Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management

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