Rituximab carries high risks of hepatitis B virus reactivation in hematologic and rheumatic patients with chronic or resolved hepatitis B

Author:

Hou Kuan‐Chu1,Su Tung‐Hung23ORCID,Kao Chien‐Neng4,Cheng Huei‐Ru2,Tseng Tai‐Chung35,Liu Chun‐Jen23ORCID,Hsieh Song‐Chou6,Kao Jia‐Horng2357ORCID

Affiliation:

1. School of Medicine National Taiwan University College of Medicine Taipei Taiwan

2. Division of Gastroenterology and Hepatology, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan

3. Hepatitis Research Center National Taiwan University Hospital Taipei Taiwan

4. Department of Internal Medicine National Taiwan University Hospital, Hsin‐Chu Branch Hsin‐Chu Taiwan

5. Department of Medical Research National Taiwan University Hospital Taipei Taiwan

6. Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan

7. Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan

Abstract

AbstractBackground and AimRituximab therapy is associated with a high risk of hepatitis B virus (HBV) reactivation. We aimed to assess whether the risk of reactivation differed among various underlying diseases and between hepatitis B surface antigen (HBsAg) carriers and patients with resolved HBV infection.MethodsWe retrospectively analyzed patients with chronic or resolved HBV infection who received rituximab without prophylactic anti‐HBV therapy at a tertiary medical center. The risks of HBV reactivation, hepatitis, and hepatic decompensation were compared between the patients with hematologic and rheumatic diseases.ResultsThere were 78 patients with hematologic diseases and 39 patients with rheumatic diseases included. Among them, 43 (59%) HBsAg‐positive patients and 24 (55%) patients with resolved HBV infection experienced HBV reactivation at a median of 14.6 months after rituximab therapy. After rituximab treatment, the 1‐year HBV reactivation rate among patients with hematologic and rheumatic diseases was 29% and 45% in HBsAg‐positive patients, respectively, while the rates were 38% and 17% in patients with resolved HBV infection. The reactivation risk continued to increase even 2 years after rituximab therapy and was comparable between hematologic and rheumatic patients. A higher baseline HBV DNA level (≥20 IU/mL vs <20 IU/mL) was an independent predictor for HBV reactivation (adjusted hazard ratio [aHR]: 10.9, 95% confidence interval [CI]: 1.1–107) and HBV‐associated hepatitis (aHR: 14.8, 95% CI: 1.4–158).ConclusionsRituximab therapy is associated with a 50–64% risk of HBV reactivation regardless of underlying diseases and HBsAg status. HBV DNA levels should be assessed before initiating rituximab.

Funder

Ministry of Science and Technology

Ministry of Health and Welfare

National Taiwan University Hospital

Publisher

Wiley

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