|
- 现金
- 62111 元
- 精华
- 26
- 帖子
- 30437
- 注册时间
- 2009-10-5
- 最后登录
- 2022-12-28
|
Recent FDA warnings on hepatitis B reactivation with immune-suppressing and anti-cancer drugs: Just the tip of the iceberg?
Adrian M. Di Bisceglie MD1,*,
Anna S. Lok MD2,
Paul Martin MD3,
Norah Terrault MD, MPH4,
Robert P. Perrillo MD5 and
Jay H. Hoofnagle MD6
DOI: 10.1002/hep.27609
Copyright © 2014 by the American Association for the Study of Liver Diseases
Issue
Cover image for Vol. 60 Issue 6
Hepatology
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)
Article has an altmetric score of 1
Author Information
1 Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MO
2 Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
3 Univerisity of Miami, Miami, Florida
4 University of California - San Francisco, San Francisco, CA
5 Baylor University Medical Center, Dallas, TX
6 Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
*Corresponding author: Adrian M. Di Bisceglie, Department of Internal Medicine, 1402 South Grand Blvd, St. Louis, MO 63104. Telephone 314-577-8760. Fax: 314-268-5108.
Abstract
Reactivation of hepatitis B in the context of immunosuppressive therapy may be severe and potentially fatal. The FDA has recently drawn attention to the potentially fatal risk of hepatitis B reactivation in patients receiving the anti-CD20 agents, ofatumumab or rituximab. This action focuses attention on the broader issue of HBV reactivation which may occur with a wide variety of immunosuppressive therapies in benign or malignant disease. This manuscript summarizes the data behind this issue. These data support the recommendation that all patients undergoing chemotherapy, immunosuppressive therapy, HSCT or solid organ transplantation be screened for active or prior HBV infection by testing for HBsAg and anti-HBc in serum. Those who are found to be HBsAg positive should start appropriate antiviral therapy to prevent reactivation. Additionally, even those who have recovered from hepatitis B will benefit from antiviral therapy in certain circumstances because of the risks associated with a form of HBV reactivation referred to as reverse seroconversion. There remain many uncertain areas that warrant further study and further advances will benefit from close interactions between various medical specialties, regulatory agencies and researchers.
CONCLUSIONS: There is good evidence to support routine screening of all patients for hepatitis B prior to undergoing chemotherapy or immunosuppressive treatment. Use of prompt antiviral treatment appears to diminish the risk of severe or fatal reactivation of hepatitis B. This article is protected by copyright. All rights reserved.
|
|
发表于 2014-11-26 14:25