Reactivation of Hepatitis B Virus: A Review of Clinical Guidelines

Myint, Anthony; Tong, Myron J.; Beaven, Simon W.

doi:10.1002/cld.883

Cited by 60 publications

(62 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13 Since the "covalent closed circular DNA" (cccDNA), which acts as a template for HBV replication in the hepatocyte nuclease of HBV-infected individuals, remains permanent, these patients have the risk of HBVr when immunosuppressive agents are used. 10 Yet, considering the current increasing use of anti-TNF-α agents, it is very important to estimate the effect of anti-TNF-α agents on HBVr, especially in countries where the total positivity of anti-HBc is relatively high. In our study, we presented real-life data of HBsAg(−)/ anti-HBc(+) patients who were initiated into anti-TNF-α therapy.…”

Section: Discussionmentioning

confidence: 99%

“…10 The patients with HBsAg positivity were identified as chronic hepatitis B infection, and those with HBsAg negative/anti-HBc positive patients were identified as resolved HBV infection. 10,11 During the follow-up of the patients, the positivity of basal HBV DNA from negativity, or increased viral load by 10 times compared to basal values, and/or the positivity of HBsAg from negativity were identified as HBVr. [10][11][12] The increase in serum alanine aminotransferase (ALT) levels at least 3 times higher than the normal upper limit (45 U/L for serum ALT) was identified as hepatitis.…”

Section: Methods and Definitionsmentioning

confidence: 99%

“…10,11 During the follow-up of the patients, the positivity of basal HBV DNA from negativity, or increased viral load by 10 times compared to basal values, and/or the positivity of HBsAg from negativity were identified as HBVr. [10][11][12] The increase in serum alanine aminotransferase (ALT) levels at least 3 times higher than the normal upper limit (45 U/L for serum ALT) was identified as hepatitis. 11 HBV-associated hepatitis was defined as clinical, biochemical evidence of hepatitis with an increase in HBV DNA.…”

Section: Methods and Definitionsmentioning

confidence: 99%

“…11 HBV-associated hepatitis was defined as clinical, biochemical evidence of hepatitis with an increase in HBV DNA. 10 The duration in anti-TNF-α treatment was identified as the time from the first anti-TNF-α prescription to the last dose. During the study period, the HBV serological markers that contained HBsAg, anti-HBs, and anti-HBc levels were assessed with the electrochemiluminescence immunoassay method using Roche Cobas E601 Device (Japan).…”

Section: Methods and Definitionsmentioning

confidence: 99%

“…Performing of HBsAg and/or anti‐HBc tests in 6 months before the first course of anti‐TNF‐α agents was identified as HBV screening 10 . The patients with HBsAg positivity were identified as chronic hepatitis B infection, and those with HBsAg negative/anti‐HBc positive patients were identified as resolved HBV infection 10,11 .…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Risk of hepatitis B reactivation in patients receiving anti‐tumor necrosis factor‐α therapy

et al. 2020

View full text Add to dashboard Cite

Objective The purpose of this study was to determine hepatitis B virus (HBV) screening rates in patients receiving anti‐tumor necrosis factor (TNF)‐α therapy and the frequency of HBV reactivation in patients with resolved hepatitis B virus infection (hepatitis B surface antigen [HBsAg] negative, hepatitis B core antibody [Anti‐HBc] positive). Patients and methods Data from 1834 patients who underwent anti‐TNF‐α therapy in the Rheumatology, Gastroenterology and Dermatology Departments of our hospital between 2010 and 2020 were retrospectively analyzed. Within 6 months before the initial anti‐TNF‐α therapy, performing a HBsAg and/or anti‐HBc test is defined as HBV screening. HBV reactivation is defined as the presence of detectable serum HBV DNA or HBsAg seroconversion from negative to positive. Results The overall HBV screening rate was 82.3% before starting anti‐TNF‐α therapy. There was an increasing trend in HBV screening rates during the years analyzed (64% in 2010, 87.4% in 2019) (P < .001). Before anti‐TNF‐α therapy was initiated, 272 patients were HBsAg negative and anti‐HBc positive. Among these patients, HBV reactivation did not occur in 31 patients who received antiviral prophylaxis, whereas HBV reactivation occurred in only 1 (0.4%) of the 241 patients who did not receive antiviral prophylaxis. Conclusion Hepatitis B virus screening rates prior to starting anti‐TNF‐α therapy were relatively high, and its trend was increased by year. HBV reactivation because of anti‐TNF‐α use rarely occurred in patients with resolved HBV infection. Further studies are needed on whether routine anti‐HBc screening and/or HBV DNA follow‐up are necessary in these patients aside from HBsAg.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methods and Definitionsmentioning

confidence: 99%

Section: Methods and Definitionsmentioning

confidence: 99%

Section: Methods and Definitionsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Risk of hepatitis B reactivation in patients receiving anti‐tumor necrosis factor‐α therapy

et al. 2020

View full text Add to dashboard Cite

show abstract

Incidence, timing, and management of infections in patients receiving teclistamab for the treatment of relapsed/refractory multiple myeloma in the MajesTEC‐1 study

Nooka,

Rodriguez,

Mateos

et al. 2023

Cancer

View full text Add to dashboard Cite

BackgroundPatients with relapsed/refractory multiple myeloma are at increased risk of infection. Infections during treatment with teclistamab, the first B‐cell maturation antigen‐directed bispecific antibody approved for triple‐class–exposed relapsed/refractory multiple myeloma, was examined in the phase 1/2 MajesTEC‐1 study.MethodsPatients (N = 165) received subcutaneous teclistamab 1.5 mg/kg weekly after a step‐up dosing schedule (0.06 mg/kg and 0.3 mg/kg, each separated by 2–4 days). Patients were monitored frequently for infections; prophylaxis and management were per institutional guidelines.ResultsAt a median follow‐up of 22.8 months (range, 0.3–33.6), infections were reported in 132 patients (80.0%). Grade 3/4 infections occurred in 91 patients (55.2%), including COVID‐19 (21.2%), respiratory infections (19.4%), Pneumocystis jirovecii pneumonia (4.2%), viral infections (4.2%), and gastrointestinal infections (1.2%). Twenty‐one patients died from infections (18 from COVID‐19). Median time to first onset of any‐grade and grade 3 to 5 infections was 1.7 and 4.2 months, respectively. Overall, 70.9% of patients had ≥1 postbaseline immunoglobulin G (IgG) level <400 mg/dL; median time to IgG <400 mg/dL was 1.2 months (range, 0.2–19.8) and 46.1% received ≥1 dose of IgG replacement. Grade 3/4 neutropenia occurred in 65.5% of patients (median time to grade ≥3 neutropenia/febrile neutropenia was 2.3 months [range, 0–18.1]).ConclusionBased on the infection profile of B‐cell maturation antigen–targeted bispecific antibodies such as teclistamab, it is recommended that clinicians and patients remain vigilant for a range of infection types throughout treatment to facilitate prompt intervention. Appropriate screening, prophylaxis, and management of infections, hypogammaglobulinemia, and neutropenia are important.Clinical trial registrationNCT03145181/NCT04557098 (ClinicalTrials.gov)Plain Language Summary Before starting teclistamab, patients should be up to date with vaccinations (including COVID‐19) and screened for hepatitis B and C and HIV. Teclistamab should not be given to patients with any active infections. Prophylactic antimicrobials should be administered per institutional guidelines. Prophylaxis for Pneumocystis jirovecii pneumonia and herpes simplex/varicella zoster virus is recommended during teclistamab treatment. Close monitoring of infections and immunoglobulin G (IgG) levels should continue throughout teclistamab treatment. IgG replacement (administered every 3–6 weeks) should be used to maintain IgG ≥400 mg/dL. Growth factors should be considered for grade ≥3 neutropenia with infection/fever and grade 4 neutropenia.

show abstract

Glofitamab as a salvage treatment for B‐cell lymphomas in the real world: A multicenter study in Taiwan

Hsu,

Wu,

Kao

et al. 2024

Cancer

View full text Add to dashboard Cite

BackgroundGlofitamab is a bispecific antibody with promise for treating relapsed/refractory B‐cell lymphoma according to a phase 1/2 clinical trial. This study examined its real‐world effectiveness.MethodsThis was an investigator‐initiated, multicenter retrospective study including 34 patients who had relapsed/refractory B‐cell lymphomas after at least three prior lines of therapy and received glofitamab monotherapy in a compassionate use program in Taiwan between January 2021 and October 2022.ResultsAt a median follow‐up of 15.9 months, 56% of patients responded to glofitamab and 23% achieved complete remission. Response to the previous line of therapy significantly correlated with response to glofitamab (p = .020). Most responses were durable; only five out of the 19 responders had documented disease recurrence at the data cutoff date. The estimated progression‐free survival (PFS) was 3.2 months, and the estimated 1‐year PFS was 33% for the entire cohort. PFS was better for responders than nonresponders (median PFS, 16.9 vs. 1.8 months; 1‐year PFS, 60% vs. 0%). Forty‐three cytokine release syndrome (CRS) events were observed, three of which were grade 3; all were manageable without glofitamab discontinuation. No immune effector cell–associated neurotoxicity was reported. Among seven hepatitis B virus (HBV) carriers (six had antiviral prophylaxis) and 14 patients with remote HBV (four had antiviral prophylaxis), no HBV reactivation was observed.ConclusionsIn this real‐world cohort, glofitamab exhibited effectiveness comparable to trial results without excessive CRS or new safety issues. With appropriate prophylaxis, glofitamab‐treated patients with chronic or remote HBV infection are unlikely to experience virus reactivation.

show abstract

Reactivation of Hepatitis B Virus: A Review of Clinical Guidelines

Cited by 60 publications

References 9 publications

Risk of hepatitis B reactivation in patients receiving anti‐tumor necrosis factor‐α therapy

Risk of hepatitis B reactivation in patients receiving anti‐tumor necrosis factor‐α therapy

Incidence, timing, and management of infections in patients receiving teclistamab for the treatment of relapsed/refractory multiple myeloma in the MajesTEC‐1 study

Glofitamab as a salvage treatment for B‐cell lymphomas in the real world: A multicenter study in Taiwan

Contact Info

Product

Resources

About