Hepatitis B virus reactivation with rituximab-containing regimen

Abstract

Rituximab is recognized as a useful drug for the treatment of B-cell non-Hodgkin's lymphoma and its use has been extended to such diseases as idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura, chronic rheumatoid arthritis and AN-CA-associated vasculitides. One serious complication associated with its use is the reactivation of hepatitis B virus and the search for methods to prevent this occurrence has resulted in the rapid accumulation of knowledge. In this review, we discuss case analyses from our department and other groups and outline the current knowledge on the topic and the remaining issues.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Rituximab; Hepatitis B virus; Reactivation; Chemotherapy; Lamivudine; Non-Hodgkin's lymphoma Core tip: The deleterious effects of hepatitis B virus (HBV) reactivation in rituximab-containing chemotherapy regimens have been reported and the effect of lamivudine treatment in the prevention of HBV reactivation is also well documented. Once reactivated, HBV may lead to death due to hepatitis. In this review, we discuss the factors of preventive lamivudine treatment (especially in the course of HBV antibody), including to whom and for how long the drug should be given, based on case studies and reports that span rituximab's debut in 2002 on the Japanese market to June 2013.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

“…Reactivation of HBV could be either spontaneous or due to intensive chemotherapy or immunosuppressive therapy [10,11], immune restoration after highly active antiretroviral therapy for HIV [12,13], treatment-related [14], or reactivation of the occult HBV infection by rituximab (anti-CD20)-based chemotherapy [15][16][17]. Similarly, reactivation of Hepatitis C virus infection has also been reported, especially after immune suppressive therapy [18,19].…”

“…Acute hepatic insults of infectious etiology included reactivation of Hepatitis B virus (HBV) as the leading cause of ACLF in the Asian region [10][11][12][13][14][15][16][17][18][19]. Reactivation of HBV could be either spontaneous or due to intensive chemotherapy or immunosuppressive therapy [10,11], immune restoration after highly active antiretroviral therapy for HIV [12,13], treatment-related [14], or reactivation of the occult HBV infection by rituximab (anti-CD20)-based chemotherapy [15][16][17].…”

Hepatitis B Reactivation in Immunosupressed Patients, Prophylaxis and Management

“…For instance, rituximab, is an agent predominantly used to treat haematological malignancy in addition to autoimmune and neurological disease. 9,10 Rituximab is an agent that works against CD20 on B-cell. CD20 positive B-cells depletion might reduce the number of CD4 memory cells, CD8 cells, and antibody-mediated immunity.…”

“…The rate of hepatitis B virus reactivation during rituximab treatment when combined with chemotherapy has been reported to be 20-55% overall and 3% in patients with negative HbsAg. 10,11 due to various chemotherapeutic/ immunosuppressive agents are shown in Table 2 and Figure 3.…”

Viral infection in primary antibody deficiency syndromes

“…No studies have been reported focussing upon CVID patients infected with hepatitis C through means other than immunoglobulin exposure, although a case study in the era prior to IVIg suggested that rapid and severe disease can occur after natural infection with hepatitis B virus . Furthermore, hepatitis B reactivation and infection severity has been shown to be significantly increased in those treated with Rituximab, an agent which targets antibody production via CD20 B cells; however, it is unclear if there is a significantly increased mortality . In prevalence studies completed in the wake of contaminated blood products, there was not a significant number of asymptomatic patients carrying viral hepatitis viruses .…”