Article

Adherence to hepatitis B screening and prophylactic lamivudine for prevention of rituximab-associated hepatitis B reactivation.

Department of Pharmacy, Karmanos Cancer Center, Detroit, MI, USA.
Journal of Oncology Pharmacy Practice 05/2012; DOI:10.1177/1078155212447975
Source: PubMed

ABSTRACT Purpose: Treatment with rituximab can be associated with hepatitis B reactivation leading to fulminant hepatitis and sometimes fatal hepatitis. The manufacturer has recommended screening the high-risk patients and monitoring hepatitis B virus carriers during and several months after the therapy. Prophylaxis with lamivudine has been recommended to prevent reactivation in hepatitis B virus carriers receiving rituximab. An institutional guideline was developed and implemented. This study evaluated the adherence to these clinical guidelines of hepatitis B screening in patients receiving rituximab-based treatment, the use of lamivudine prophylaxis, and the prevalence of positive hepatitis B virus surface antigen in this patient population in southeast Michigan. METHODS: A retrospective chart review of patients begun on rituximab therapy from January 2009 through June 2010 was conducted. RESULTS: Two hundred and eighty patients who received rituximab were identified. Approximately 70% of patients had hepatitis B virus surface antigen screening test prior to rituximab therapy. Antibody to hepatitis B virus core antigen was detected in 11.1% of patients, although the hepatitis B virus surface antigen positive rate was only 0.6%. One patient had hepatitis B virus reactivation despite lamivudine prophylaxis, but fully recovered after antiviral therapy was changed to tenofovir. CONCLUSION: The prevalence of hepatitis B virus surface antigen positivity is low in this study; however, antibody to hepatitis B virus core antigen positivity is high. Education to clinicians is warranted to increase awareness and further improve adherence to the clinical guidelines.

0 0
 · 
0 Bookmarks
 · 
53 Views
  • Article: Hepatitis B virus management to prevent reactivation after chemotherapy: a review.
    Jessica P Hwang, John M Vierling, Andrew D Zelenetz, Susan C Lackey, Rohit Loomba
    [show abstract] [hide abstract]
    ABSTRACT: Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy. We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library. Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests-HBsAg, anti-HBc, and anti-HBs-allows the most thorough interpretation of a patient's serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies. Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.
    Supportive Care in Cancer 08/2012; 20(11):2999-3008. · 2.09 Impact Factor
  • Article: Clinical use of biologics in vasculitis syndromes.
    Marino Paroli
    [show abstract] [hide abstract]
    ABSTRACT: Vasculitis syndromes are relative rare conditions but can cause significant mortality and morbidity if not treated adequately. Recent advances in immunosuppressant therapy have radically changed the course of these diseases. However, the standard therapy is not always well tolerated by patients, and some cases are refractory to treatment. New therapeutic possibilities have emerged with the use of so-called "biologics," a new class of genetically engineered drugs used for inflammatory rheumatic diseases, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. In the present review, summarized are the most recent data on the efficacy and safety of biologics in the treatment of vasculitis syndromes that cannot be treated with standard therapy.
    Biologics: Targets & Therapy 01/2012; 6:371-8.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

clinical guidelines
 
fulminant hepatitis
 
hepatitis B reactivation
 
hepatitis B screening
 
hepatitis B virus carriers
 
hepatitis B virus core antigen
 
hepatitis B virus core antigen positivity
 
hepatitis B virus surface antigen positive rate
 
hepatitis B virus surface antigen positivity
 
high-risk patients
 
increase awareness
 
institutional guideline
 
lamivudine prophylaxis
 
monitoring hepatitis B virus carriers
 
patient population
 
positive hepatitis B virus surface antigen
 
retrospective chart review
 
rituximab
 
rituximab therapy
 
rituximab-based treatment