Randomized Controlled Trial of Entecavir Prophylaxis for Rituximab-Associated Hepatitis B Virus Reactivation in Patients With Lymphoma and Resolved Hepatitis B

Huang, Yi Hsiang; Hsiao, Liang Tsai; Hong, Ying; Chiou, Tzeon Jye; Yu, Yuan Bin; Gau, Jyh Pyng; Liu, Chia Jen; Yang, Muh Hwa; Tzeng, Cheng Hwai; Lee, Pui Ching; Lin, Han Chieh; Lee, Shou Dong

doi:10.1200/jco.2012.48.5938

Cited by 303 publications

(295 citation statements)

References 31 publications

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“…[210][211][212] Prophylaxis with ETV or TDF or TAF can be also considered in HBsAg-negative, anti-HBc positive patients receiving highly immunosuppressive regimens of extended duration. 213,214 In HBsAg-negative, anti-HBc positive subjects with moderate (\10%) or low (\1%) risk of HBV reactivation, pre-emptive therapy, not prophylaxis, is generally recommended. 205,206 The main virological event in these anti-HBc positive patients is HBsAg reappearance (seroreversion), constantly associated with hepatitis flare; by converse HBV DNA detection leads to seroreversion and hepatitis in only 50% of cases.…”

Section: -209mentioning

confidence: 99%

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Lampertico¹,

Agarwal²,

Berg³

et al. 2017

Journal of Hepatology

4,184

3,081

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Section: -209mentioning

confidence: 99%

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Lampertico¹,

Agarwal²,

Berg³

et al. 2017

Journal of Hepatology

4,184

3,081

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“…These 2 studies also showed that most HBV reactivation was observed within 1 year after completion of rituximab-containing chemotherapy, which again suggests that the monitoring of HBV DNA should be continued for at least 1 year after the completion of anti-B-cell therapy. Conversely, although antiviral prophylaxis is an alternative approach to preventing HBV reactivation in patients with resolved HBV infection, 40 there are some concerns, such as emergence of drug resistance and cost-effectiveness, that also need to be addressed. 41 …”

Section: Strategy To Prevent Hbv Reactivation In Hbsag-positive Patientsmentioning

confidence: 99%

Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy

Kusumoto

Tobinai

2014

Hematology

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Reactivation of hepatitis B virus (HBV) is a potentially fatal complication after anti-B-cell therapy. It can develop not only in patients seropositive for hepatitis B surface antigen (HBsAg), but also in those with resolved HBV infection who are seronegative for HBsAg but seropositive for antibodies against hepatitis B core antigen (anti-HBc) and/or antibodies against HBsAg (anti-HBs). The risk of HBV reactivation depends on the balance between replication of the virus and the immune response of the host. Anti-CD20 monoclonal antibody-rituximab in combination with steroid-containing chemotherapy (R-CHOP: rituximab ϩ cyclophosphamide ϩ hydroxydaunorubicin ϩ vincristine ϩ prednisone/prednisolone)-is an important risk factor for HBV reactivation in HBsAg-negative patients. More obviously, HBsAg-positive patients are considered to be at very high risk for HBV reactivation and, in the rituximab era, 59%-80% of these patients develop HBV reactivation after R-CHOP-like chemotherapy. Patients with resolved HBV infection should also be considered at high risk of HBV reactivation, the incidence of which is reported to be 9%-24% in such lymphoma patients. All patients should be screened to identify risk groups for HBV reactivation before initiating anti-B-cell therapy by measuring serum HBV markers including HBsAg, anti-HBc and anti-HBs. To prevent the development of hepatitis due to HBV reactivation after anti-B-cell therapy, antiviral prophylaxis is recommended for HBsAg-positive patients and/or patients in whom HBV DNA is detectable at baseline, whereas regular monitoring of HBV DNA-guided preemptive antiviral therapy is a reasonable and useful approach for patients with resolved HBV infection. Learning Objectives• To become familiar with the risk of HBV reactivation in patients who receive anti-B-cell therapy • To manage such high-risk patients successfully using antiviral prophylaxis or by HBV DNA-monitoring-guided preemptive antiviral therapy

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“…Also entecavir has been proposed in the prophylaxis of reactivation of OBI. In a randomized controlled trial [89] 80 patients with CD20+ lymphoma and resolved hepatitis B were randomly assigned to a prophylactic schedule with entecavir, started before rituximab-based chemotherapy and stopped 3 mo after its discontinuation, or to be treated with entecavir once HBV reactivation and reversion to HBsAg positivity had occurred (control group). During an 18-mo follow up, HBV reactivation occurred in 2.4% of patients who underwent entecavir prophylaxis and in 17.9% of cases in the control group (P < 0.05).…”

Section: Occult Hbv Infection In Hiv-positive Subjectsmentioning

confidence: 99%

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Sagnelli

Pisaturo

Martini

et al. 2014

WJH

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Randomized Controlled Trial of Entecavir Prophylaxis for Rituximab-Associated Hepatitis B Virus Reactivation in Patients With Lymphoma and Resolved Hepatitis B

Abstract: Undetectable HBV viral load before chemotherapy did not confer reactivation-free status. Antiviral prophylaxis can potentially prevent rituximab-associated HBV reactivation in patients with lymphoma and resolved hepatitis B.

Cited by 303 publications

References 31 publications

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

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