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Multicenter Study
. 2023 Feb:108:68-73.
doi: 10.1016/j.ejim.2022.11.024. Epub 2022 Nov 30.

Patients treated with rituximab are poorly screened for hepatitis B infection: Data from a low-incidence country

Sylvia M Brakenhoff  1 , Roos Hoekstra  2 , Pieter Honkoop  3 , Robert Roomer  4 , Jan G den Hollander  5 , Geert Bezemer  6 , Robert J de Knegt  2 , Milan J Sonneveld  2 , Robert A de Man  2
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Free article
Multicenter Study

Patients treated with rituximab are poorly screened for hepatitis B infection: Data from a low-incidence country

Sylvia M Brakenhoff et al. Eur J Intern Med. 2023 Feb.
Free article

Abstract

Background & aims: Patients with chronic or resolved hepatitis B are at risk of hepatitis B reactivation (HBVr) when treated with high-risk immunosuppressive therapy such as rituximab. Therefore, international guidelines recommend HBV screening prior to rituximab treatment and subsequent antiviral prophylaxis among patients with a (resolved) infection. In this study, we evaluated the adherence to those recommendations.

Methods: This is a retrospective multicentre study including patients treated with rituximab between 2000-2021. Performance of correct screening was assessed, defined as the measurement of hepatitis B surface antigen (HBsAg) and hepatitis B core antibodies (anti-HBc). Next, initiation of antiviral prophylaxis and HBVr rate among patients with a chronic or resolved HBV infection was studied.

Results: We enrolled 3,176 patients of whom 1,448 (46%) were screened correctly. Screening rates differed significantly between academic and non-academic hospitals; respectively 65% vs 32% (p<0.001). In addition, screening rates differed across specialties and improved throughout the years; from 32% before 2012 to 75% after 2020 among academic prescribers, versus 1% to 60% among non-academic prescribers (both p<0.001). Antiviral prophylaxis was initiated in 58% vs 36% of the patients with a chronic or resolved HBV infection. Seven patients experienced HBVr, including one fatal liver decompensation.

Conclusions: Many patients treated with rituximab were not correctly screened for HBV infection and antiviral prophylaxis was often not initiated. Although screening rates improved over time, rates remain suboptimal. With the increasing number of indications for rituximab and other immunosuppressive agents these findings could raise awareness among all medical specialties prescribing these agents.

Keywords: Anti-CD20; Cytotoxic agents; HBV; Hepatitis B; Hepatitis B reactivation; Immunosuppressive agents; Rituximab.

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Conflict of interest statement

Conflict of interest disclosure SB received an unrestricted research grant from Gilead. RdK has received honoraria for consulting/speaking from Gilead, Janssen, echosens, AbbVie, and Norgine and received research grants form Gilead and Janssen. MS has received speaker's fees and research support from Roche, Innogenetics, BMS, Gilead and Fujirebio. The other authors report no disclosures.

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