Prevention of Hepatitis B reactivation in the setting of immunosuppression

Pattullo, Venessa

doi:10.3350/cmh.2016.0024

Cited by 113 publications

(93 citation statements)

References 157 publications

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“…Chronic active HBV patients already successfully controlled with antiviral therapy prior to introduction of anti‐TNF show no deterioration in the viral load or liver enzymes . A comprehensive review by Pattullo looked at incidence & prevalence of HBV reactivation in IBD when treated with immunosuppressants without HBV prophylaxis; risk stratification of patients was also done based on type of biologic therapy . The incidence of immunosuppression related HBV reactivation was noted to be about 36% in HBsAg positive patients.…”

Section: Aims and Methodsmentioning

confidence: 99%

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Review article: managing the adverse events caused by anti‐TNF therapy in inflammatory bowel disease

Shivaji

Sharratt

Thomas

et al. 2019

Aliment Pharmacol Ther

128

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Background: Biological therapy is currently widely used to treat IBD. Infliximab, adalimumab and golimumab are currently licensed anti-TNF therapies. Biosimilar anti-TNF monoclonal antibodies are increasingly used. Anti-TNF therapies are widely used and their adverse effects are well characterised, and may cause significant morbidity and mortality in a small proportion of exposed patients. Gastroenterologists need to understand the mechanisms for these effects, recognise these swiftly and manage such events appropriately. Aim:To cover the range of potential adverse reactions as a result of biologic therapy and specifically management of these events. Methods: A Medline and Pubmed search was undertaken. Search terms includedwere "anti-TNF," "infliximab" or "adalimumab" or "golimumab" combined with the keywords "ulcerative colitis" or "Crohn's disease" or "inflammatory bowel disease" and then narrowed to articles containing the keywords "complications," "side effects" or "adverse events" or "safety profile." International guidelines were also reviewed where relevant.Results: Adverse events discussed in this review include infusion reactions, blood disorders and infections (including bacterial, viral, fungal and opportunistic infections) as well as autoimmune, dermatological disorders, cardiac and neurological conditions. Malignancies including solid organ, haematological and those linked to viral disease are discussed. Conclusions:Anti-TNF therapy has wide-ranging effects on the immune system resulting in a spectrum of potential adverse events in a small proportion of patients.Research advances are improving the understanding, recognition and management of these adverse events.

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Section: Aims and Methodsmentioning

confidence: 99%

“…The overall prevalence of HBV in IBD ranged from 0.6%‐17% for HBsAg positive patients, and 1.6%‐42% for HBsAg negative/anti‐HBc positive patients. The risk estimate of HBV reactivation was reported to be moderate (1%‐10%) with anti‐TNF …”

Section: Aims and Methodsmentioning

confidence: 99%

Review article: managing the adverse events caused by anti‐TNF therapy in inflammatory bowel disease

Shivaji

Sharratt

Thomas

et al. 2019

Aliment Pharmacol Ther

128

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“…In addition, antiviral prophylaxis should be administered for 12‐18 months after stopping immunosuppression. Nevertheless, such duration is still under debate . In this light, our study aimed to provide evidence from real clinical practice on virological and clinical features of patients developing immunosuppression‐driven HBV reactivation in one of the largest cohorts of HBV‐reactivated patients collected so far.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,5 Antiviral prophylaxis (based on the administration of a nucleoside analogue inhibitor) has been proposed to prevent HBV reactivation in patients with HBeAg-negative chronic HBV infection and in anti-HBc-positive/HBsAg-negative patients, at high risk of HBV reactivation. [5][6][7] Antiviral prophylaxis significantly reduces but does not abrogate the risk of reactivation. In addition, antiviral prophylaxis should be administered for 12-18 months after stopping immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

A snapshot of virological presentation and outcome of immunosuppression‐driven HBV reactivation from real clinical practice: Evidence of a relevant risk of death and evolution from silent to chronic infection

Salpini

Battisti

Colagrossi

et al. 2019

Journal of Viral Hepatitis

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The study was undertaken in order to provide a snapshot from real clinical practice of virological presentation and outcome of patients developing immunosuppression‐driven HBV reactivation. Seventy patients with HBV reactivation were included (66.2% treated with rituximab, 10% with corticosteroids and 23.8% with other immunosuppressive drugs). Following HBV reactivation, patients received anti‐HBV treatment for a median (IQR) follow‐up of 31(13‐47) months. At baseline‐screening, 72.9% of patients were HBsAg‐negative and 27.1% HBsAg‐positive. About 71.4% had a diagnosis of biochemical reactivation [median (IQR) HBV DNA and ALT: 6.9 (5.4‐7.8) log IU/mL and 359 (102‐775) U/L]. Moreover, 10% of patients died from hepatic failure. Antiviral prophylaxis was documented in 57.9% and 15.7% of HBsAg‐positive and HBsAg‐negative patients at baseline‐screening (median [IQR] prophylaxis duration: 24[15‐33] and 25[17‐36] months, respectively). Notably, HBV reactivation occurred 2‐24 months after completing the recommended course of anti‐HBV prophylaxis in 35.3% of patients. By analysing treatment outcome, the cumulative probability of ALT normalization and of virological suppression was 97% and 69%, respectively. Nevertheless, in patients negative to HBsAg at baseline‐screening, only 27% returned to HBsAg‐negative status during prolonged follow‐up, suggesting the establishment of chronic infection. In conclusion, most patients received a diagnosis of HBV reactivation accompanied by high ALT and 10% died for hepatic failure, supporting the importance of strict monitoring for an early HBV reactivation diagnosis. Furthermore, HBV reactivation correlates with high risk of HBV chronicity in patients negative for HBsAg at baseline‐screening, converting a silent into a chronic infection, requiring long‐term antiviral treatment. Finally, a relevant proportion of patients experienced HBV reactivation after completing the recommended course of anti‐HBV prophylaxis, suggesting the need to reconsider proper duration of prophylaxis particularly in profound immunosuppression.

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“…HBV infection acquired in childhood advances to chronic hepatitis B that requires treatment [1]. If HBV infection is not treated adequately, it can have serious sequelae, such as liver cirrhosis and hepatocellular carcinoma [2–4]. Although both the prevalence of and interest in hepatitis C virus infection have increased recently, HBV infection remains an important issue in terms of viral hepatitis [5].…”

Section: Introductionmentioning

confidence: 99%

Changes in hepatitis B virus antibody titers over time among children: a single center study from 2012 to 2015 in an urban of South Korea

et al. 2017

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BackgroundHepatitis B virus (HBV) infection is the most common cause of liver disease in endemic areas such as South Korea. After HBV vaccination, hepatitis B surface antibody (HBsAb) titers gradually decrease. Trends in HBsAb titers have not been evaluated among children in South Korea over the past decade.MethodsWe screened 6155 patients (aged 7 months to 17 years) who underwent HBV antigen/antibody testing at Chung-Ang University Hospital from May 2012 to April 2015. Titer criteria were defined as follows: positive, titer ≥100 IU/L; weakly positive, titer 10–99 IU/L; and negative, titer <10 IU/L. We also compared titers before and 1 month after a single booster vaccination.ResultsOf the 5655 patients included, 3016 were male and 5 (0.09%) tested positive for HBV surface antigen. A marked reduction in antibody titer was observed until 4 years of age. Thereafter, the titers showed fluctuating decreases. HBsAb titers reached their lowest levels by 14 years of age. After 7 years of age, 50% of patients tested negative for HBsAb. Simple linear analysis showed that the titer reached levels of <10 IU/L and zero at 12.9 and 13.4 years of age, respectively. 1 month after a single booster vaccination was administered to those who were HBsAb-negative (n = 72), 69 children (96%) had developed antibodies while 3 (4%) remained HBsAb-negative.ConclusionsIn conclusion, the continuous reduction in HBsAb titers over time and in each age group was confirmed. The titer level was shown significant decline until age 4. More than half of the sample had negative titers after age 7 years. After booster vaccination, most of child significantly increase titer level.

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Prevention of Hepatitis B reactivation in the setting of immunosuppression

Cited by 113 publications

References 157 publications

Review article: managing the adverse events caused by anti‐TNF therapy in inflammatory bowel disease

Review article: managing the adverse events caused by anti‐TNF therapy in inflammatory bowel disease

A snapshot of virological presentation and outcome of immunosuppression‐driven HBV reactivation from real clinical practice: Evidence of a relevant risk of death and evolution from silent to chronic infection

Changes in hepatitis B virus antibody titers over time among children: a single center study from 2012 to 2015 in an urban of South Korea

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