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Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas
BACKGROUND/AIMS: Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate i...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Editorial Office of Gut and Liver
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018307/ https://www.ncbi.nlm.nih.gov/pubmed/36268584 http://dx.doi.org/10.5009/gnl210551 |
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author | Lan, Ting-Yuan Lin, Yen-Chun Tseng, Tai-Chung Yang, Hung-Chih Kao, Jui-Hung Cheng, Chiao-Feng Lee, Tai-Ju Huang, Shang-Chin Lu, Cheng-Hsun Li, Ko-Jen Hsieh, Song-Chou |
author_facet | Lan, Ting-Yuan Lin, Yen-Chun Tseng, Tai-Chung Yang, Hung-Chih Kao, Jui-Hung Cheng, Chiao-Feng Lee, Tai-Ju Huang, Shang-Chin Lu, Cheng-Hsun Li, Ko-Jen Hsieh, Song-Chou |
author_sort | Lan, Ting-Yuan |
collection | PubMed |
description | BACKGROUND/AIMS: Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. METHODS: From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed. RESULTS: After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). CONCLUSIONS: In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAg-negative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc. |
format | Online Article Text |
id | pubmed-10018307 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Editorial Office of Gut and Liver |
record_format | MEDLINE/PubMed |
spelling | pubmed-100183072023-03-17 Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas Lan, Ting-Yuan Lin, Yen-Chun Tseng, Tai-Chung Yang, Hung-Chih Kao, Jui-Hung Cheng, Chiao-Feng Lee, Tai-Ju Huang, Shang-Chin Lu, Cheng-Hsun Li, Ko-Jen Hsieh, Song-Chou Gut Liver Original Article BACKGROUND/AIMS: Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. METHODS: From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed. RESULTS: After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). CONCLUSIONS: In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAg-negative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc. Editorial Office of Gut and Liver 2023-03-15 2022-10-21 /pmc/articles/PMC10018307/ /pubmed/36268584 http://dx.doi.org/10.5009/gnl210551 Text en Copyright © Gut and Liver. https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lan, Ting-Yuan Lin, Yen-Chun Tseng, Tai-Chung Yang, Hung-Chih Kao, Jui-Hung Cheng, Chiao-Feng Lee, Tai-Ju Huang, Shang-Chin Lu, Cheng-Hsun Li, Ko-Jen Hsieh, Song-Chou Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas |
title | Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas |
title_full | Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas |
title_fullStr | Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas |
title_full_unstemmed | Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas |
title_short | Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas |
title_sort | risk of hepatitis b virus (hbv) reactivation in hbsag-negative, anti-hbc-negative patients receiving rituximab for autoimmune diseases in hbv endemic areas |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018307/ https://www.ncbi.nlm.nih.gov/pubmed/36268584 http://dx.doi.org/10.5009/gnl210551 |
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