Efficient Prophylactic Management of HBV Reactivation by an Information Technology Encoding System: Results of a 6-year Prospective Cohort Study

Abstract

Objective We started an information technology (IT) system that encodes the medical treatment status of hepatitis B virrus (HBV) with a 9-digit number, automatically checks for inappropriate situations occurring due to immunosuppression and chemotherapy that do not comply with the flowchart of the hepatitis B countermeasure guideline, and promotes correct HBV medical treatment in our hospital. We conducted a prospective study of HBV reactivation using this system. Methods Among 21,607 cases that were managed using this system, 1,206 patients who were HBs antigen-negative, HBc antibody- and/or HBs antibody-positive and in whom HBV DNA quantification was performed two times or more were examined for the occurrence of HBV reactivation. The study population included: malignant lymphoma patients using rituximab (n=40), patients with malignant tumors using anticancer agents (n=546), patients treated with steroids (n=274), rheumatoid arthritis (RA) patients (n=144), patients using immunosuppressants/biologics (n=26), and patients undergoing hepatitis C direct acting antiviral (DAA) treatment (n=176). Results HBV reactivation was observed in 27 cases undergoing treatment with the following agents: rituximab (n=6), anticancer agents (n=8), steroids (n=10), anti-RA agents (n=1), and hepatitis C DAA (n=2). Among the 40 patients who were using rituximab, 6 (18.2%) showed a high rate of reactivation. In 10 in which HBV reactivation occurred at a median of 10 (range, 4-32) months after steroid administration, 6 occurred after the 7th month, and 1 patient showed HBs antigen positivity and severe hepatitis. Conclusion Continuing of the operation of an automatic check system using coded medical information to check for the reactivation enabled this prospective study of HBV reactivation. Careful attention should be paid to patients using steroids, as well as malignant lymphoma patients who are treated with rituximab. The results of the present study suggest that the present IT encoding system would be useful for preventing HBV reactivation.

Hepatitis B virus reactivation associated with new classes of immunosuppressants and immunomodulators: A systematic review, meta-analysis, and expert opinion

“…There were 6 studies including 3866 patients receiving only corticosteroids (Table S1a). 20,[67][68][69][70][71] Two studies included 1728 HBsAg+ patients. In one study, 68 8/72 (11%) patients without NA prophylaxis developed HBVr and all 8 patients were reported to have HBVr-associated hepatitis as well, but none developed liver decompensation or died.…”

“…In the second study, 71 which only assessed mortality, 36/1447 (2.5%) patients without but 0/209 with NA prophylaxis were reported to have died due to HBVr (Table S2a1). In four studies including 2138 HBsAg-/anti-HBc+ patients all without NA prophylaxis 20,67,69,70 (Table S1a), the pooled HBVr rate was 3% (95%CI:1-6%; heterogeneity, p<0.01), and no patient died. In three of the latter studies providing such data, 20,67,69 only 1/338 (0.3%) patients experienced HBVr-associated hepatitis (pooled rate: 0%, 95%CI:0-2%; heterogeneity, p=1.00) and no patient developed decompensation (Table S2a2).…”

HBV Reactivation During the Treatment of Non-Hodgkin Lymphoma and Management Strategies

“…The authors reported that the cumulative incidence of HBV-R at 9 months was significantly higher in the corticosteroid treatment group (38 vs. 73%, P = 0.03) (63). In a recent 6-year prospective cohort study, HBV-R was reported to occur a median of 10 months (range, 4-32) after steroid administration (53).…”

“…The HBV-R rate in NHL patients has been reported to vary between 18.2 and 80%. HBV-R occurs from after a few weeks to up to 55 months after rituximab administration, indicating that rituximab represents a very high-risk factor for HBV-R (48,(53)(54)(55)(56)(57). Between 1997 and 2009, the US Food and Drug Administration (FDA) MedWatch Database reported 118 cases of HBV-R.…”

“…73%, P = 0.03) ( 63 ). In a recent 6-year prospective cohort study, HBV-R was reported to occur a median of 10 months (range, 4–32) after steroid administration ( 53 ).…”