先前功能性治疗患者的药物治疗诱导的乙型肝炎再激活：系

StephenW

Ann Pharmacother. 2018 Sep 11:1060028018800501. doi: 10.1177/1060028018800501. [Epub ahead of print]
Pharmacotherapy-Induced Hepatitis B Reactivation Among Patients With Prior Functional Cure: A Systematic Review.
Bath RM1, Doering BE1, Nailor MD2, Goodlet KJ1.
Author information

1
    1 Midwestern University College of Pharmacy, Glendale, AZ, USA.
2
    2 St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.

Abstract
OBJECTIVE:

To describe and quantify the incidence and morbidity of hepatitis B reactivation (HBVr) secondary to pharmaceutical agents (eg, rituximab, tumor necrosis factor inhibitors, direct-acting antivirals [DAAs] for hepatitis C) among patients with previously resolved hepatitis B infection.
DATA SOURCES:

The MEDLINE database was searched from inception through July 2018 using the terms hepatitis B + ( reactivation OR [drug or drug class linked to HBVr]).
STUDY SELECTION AND DATA EXTRACTION:

Relevant English-language cohort studies or randomized trials quantifying the incidence of HBVr secondary to pharmacotherapy among patients negative for hepatitis B surface antigen and DNA and positive for hepatitis B core antibody were included.
DATA SYNTHESIS:

Among 2045 articles, 102 met inclusion criteria. Receipt of rituximab was associated with the highest risk of HBVr (for oncological indication: 6.2% rate [225/3601 patients]) and subsequent hepatitis (up to 52.4% of all HBVr cases). Biologic agents for autoimmune disease were uncommonly associated with HBVr (2.4%, 56/2338), with only 4 cases of hepatitis, all attributable to rituximab. Reactivation caused by DAAs was rare (0.3%, 28/8398), with no cases of hepatitis. Relevance to Patient Care/Clinical Practice: This review compares and contrasts the incidence and clinical relevance of HBVr for various pharmacotherapies among patients with functionally cured hepatitis B, with discussion of appropriate risk mitigation strategies.
CONCLUSIONS:

Among patients with prior functional cure of hepatitis B, prophylactic antiviral therapy is recommended with rituximab administration irrespective of indication because of a high risk for HBVr-associated morbidity. Enhanced monitoring alone is reasonable for patients receiving nonrituximab biologics or DAAs.
KEYWORDS:

direct-acting antiviral; drug safety; hepatitis B; immunosuppressant; reactivation; rituximab

PMID:
    30203666
DOI:
    10.1177/1060028018800501

StephenW

安药剂师。 2018年9月11日：1060028018800501。 doi：10.1177 / 1060028018800501。 [提前打印]
先前功能性治疗患者的药物治疗诱导的乙型肝炎再激活：系统评价。
浴室RM1，Doering BE1，Nailor MD2，Goodlet KJ1。
作者信息

1
    1中西部大学药学院，美国亚利桑那州格伦代尔。
2
    2美国亚利桑那州凤凰城圣约瑟夫医院和医疗中心。

抽象
目的：

描述和量化先前已解决的乙型肝炎感染患者中继发于药剂（例如，利妥昔单抗，肿瘤坏死因子抑制剂，丙型肝炎的直接作用抗病毒药物[DAAs]）的乙型肝炎再激活（HBVr）的发生率和发病率。
数据源：

MEDLINE数据库从开始到2018年7月使用术语乙型肝炎+（再激活OR [与HBVr相关的药物或药物类别]）进行检索。
研究选择和数据提取：

纳入了相关的英语队列研究或随机试验，量化乙型肝炎表面抗原和DNA阴性和乙型肝炎核心抗体阳性的患者中药物治疗继发HBVr的发生率。
数据综合：

在2045篇文章中，102篇符合纳入标准。利妥昔单抗的接收与HBVr的最高风险相关（对于肿瘤适应症：6.2％的患者[225/3601患者]）和随后的肝炎（高达所有HBVr病例的52.4％）。自身免疫性疾病的生物制剂与HBVr罕见相关（2.4％，56/2338），只有4例肝炎，均归因于利妥昔单抗。由DAA引起的再激活很少（0.3％，28/898），没有肝炎病例。与患者护理/临床实践的相关性：本综述比较和对比了HBVr在功能性治愈的乙型肝炎患者中各种药物治疗的发生率和临床相关性，并讨论了适当的风险缓解策略。
结论：

在先前功能性治愈乙型肝炎的患者中，推荐使用利妥昔单抗进行预防性抗病毒治疗，不论其适应症，因为HBVr相关发病率高。单独增强监测对于接受非古生物生物制剂或DAA的患者是合理的。
关键词：

直接作用的抗病毒药;药物安全;乙型肝炎;免疫抑制剂;激活;利妥昔单抗

结论：
    30203666
DOI：
    10.1177 / 1060028018800501