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Conference Paper: Feasibility of strategic monitoring in patients with prior HBV exposure undergoing anti-CD20 monoclonal antibody therapy: a prospective observational study
Title | Feasibility of strategic monitoring in patients with prior HBV exposure undergoing anti-CD20 monoclonal antibody therapy: a prospective observational study |
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Authors | |
Issue Date | 2017 |
Publisher | John Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/ |
Citation | The 68th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): The Liver Meeting 2017, Washington, DC, USA, 20-24 October 2017. In Hepatology, 2017, v. 66 n. 1, Suppl. 1, p. 1009A, abstract no. 1902 How to Cite? |
Abstract | Background: The use of anti-CD20 monoclonal antibody therapy for malignant and non-malignant diseases is increasing worldwide with the availability of biosimilars. The feasibility of a simple monitoring strategy based on hepatitis B virus (HBV) serology and liver biochemistry in hepatitis B surface antigen (HBsAg)-negative, antibody to the hepatitis B core antigen (anti-HBc)-positive individuals receiving rituximab-containing chemotherapy has not been explored. Methods: From October 2013 onwards, we
recruited HBsAg-negative, anti-HBc-positive Asian patients with baseline undetectable serum HBV DNA (<20 IU/mL), diagnosed with lymphoid malignancies and receiving anti-CD20 monoclonal antibodies (rituximab, ofatumumab or obinutuzumab). Liver biochemistry, HBV serology and serum HBV DNA levels were prospectively monitored every 4 weeks up to 2 years. Upon HBV reactivation, defined by detectable HBV DNA, the monitoring interval was intensified to every 2 weeks. Entecavir was started upon active HBV disease, defined as either hepatitis B surface antigen (HBsAg) seroreversion, or biochemical hepatitis (alanine aminotransferase (ALT) >60 U/L for men, >38 U/L for women). This study was terminated in May 2017 upon territory-wide adaptation of antiviral prophylaxis in the Hong Kong public health system. Results: 83 consecutive HBsAg-negative, anti-HBc positive patients (mean age 68±11.4 years, 57.8% male), with a median follow-up duration of 68 (range 4-104) weeks, were recruited. In this interim analysis of 70 patients, the cumulative 2-year HBV reactivation rate calculated by the Kaplan-Meier method was 23.3%, with the median HBV DNA level at reactivation 94 (range 22-1040) IU/mL. Patients with negative antibody to HBsAg (anti-HBs) levels, when compared to anti-HBs positive patients, had a significantly higher rate of reactivation (41.2% vs 15.0%, p=0.005). Among the 14
patients (20.0%) who developed reactivation, 7 (50%) progressed to active HBV disease after a median duration of 9 (range 2-16) weeks (median HBV DNA 69,600 IU/mL), of which 6 (85.7%) developed HBsAg seroreversion and 5 (71.4%) developed biochemical hepatitis (ALT ranging 32-96 U/L). Entecavir successfully controlled all 7 cases of active HBV with subsequent ALT normalization and HBV
DNA becoming undetectable, without any cases of hepatic
decompensation. Conclusion: In occult viral carriers
receiving anti-CD20 monoclonal antibodies, regular monitoring
of liver biochemistry and HBV serology could be a
feasible alternative to antiviral prophylaxis or HBV DNA
monitoring, especially in resource-constrained regions.
(ClinicalTrials.gov identifier NCT 03155984). |
Description | Poster presentation |
Persistent Identifier | http://hdl.handle.net/10722/253585 |
ISSN | 2023 Impact Factor: 12.9 2023 SCImago Journal Rankings: 5.011 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Seto, WKW | - |
dc.contributor.author | Mak, LY | - |
dc.contributor.author | Liu, SHK | - |
dc.contributor.author | Cheung, KS | - |
dc.contributor.author | Fung, JYY | - |
dc.contributor.author | Wong, DKH | - |
dc.contributor.author | Lai, CL | - |
dc.contributor.author | Yuen, RMF | - |
dc.date.accessioned | 2018-05-21T02:59:59Z | - |
dc.date.available | 2018-05-21T02:59:59Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | The 68th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): The Liver Meeting 2017, Washington, DC, USA, 20-24 October 2017. In Hepatology, 2017, v. 66 n. 1, Suppl. 1, p. 1009A, abstract no. 1902 | - |
dc.identifier.issn | 0270-9139 | - |
dc.identifier.uri | http://hdl.handle.net/10722/253585 | - |
dc.description | Poster presentation | - |
dc.description.abstract | Background: The use of anti-CD20 monoclonal antibody therapy for malignant and non-malignant diseases is increasing worldwide with the availability of biosimilars. The feasibility of a simple monitoring strategy based on hepatitis B virus (HBV) serology and liver biochemistry in hepatitis B surface antigen (HBsAg)-negative, antibody to the hepatitis B core antigen (anti-HBc)-positive individuals receiving rituximab-containing chemotherapy has not been explored. Methods: From October 2013 onwards, we recruited HBsAg-negative, anti-HBc-positive Asian patients with baseline undetectable serum HBV DNA (<20 IU/mL), diagnosed with lymphoid malignancies and receiving anti-CD20 monoclonal antibodies (rituximab, ofatumumab or obinutuzumab). Liver biochemistry, HBV serology and serum HBV DNA levels were prospectively monitored every 4 weeks up to 2 years. Upon HBV reactivation, defined by detectable HBV DNA, the monitoring interval was intensified to every 2 weeks. Entecavir was started upon active HBV disease, defined as either hepatitis B surface antigen (HBsAg) seroreversion, or biochemical hepatitis (alanine aminotransferase (ALT) >60 U/L for men, >38 U/L for women). This study was terminated in May 2017 upon territory-wide adaptation of antiviral prophylaxis in the Hong Kong public health system. Results: 83 consecutive HBsAg-negative, anti-HBc positive patients (mean age 68±11.4 years, 57.8% male), with a median follow-up duration of 68 (range 4-104) weeks, were recruited. In this interim analysis of 70 patients, the cumulative 2-year HBV reactivation rate calculated by the Kaplan-Meier method was 23.3%, with the median HBV DNA level at reactivation 94 (range 22-1040) IU/mL. Patients with negative antibody to HBsAg (anti-HBs) levels, when compared to anti-HBs positive patients, had a significantly higher rate of reactivation (41.2% vs 15.0%, p=0.005). Among the 14 patients (20.0%) who developed reactivation, 7 (50%) progressed to active HBV disease after a median duration of 9 (range 2-16) weeks (median HBV DNA 69,600 IU/mL), of which 6 (85.7%) developed HBsAg seroreversion and 5 (71.4%) developed biochemical hepatitis (ALT ranging 32-96 U/L). Entecavir successfully controlled all 7 cases of active HBV with subsequent ALT normalization and HBV DNA becoming undetectable, without any cases of hepatic decompensation. Conclusion: In occult viral carriers receiving anti-CD20 monoclonal antibodies, regular monitoring of liver biochemistry and HBV serology could be a feasible alternative to antiviral prophylaxis or HBV DNA monitoring, especially in resource-constrained regions. (ClinicalTrials.gov identifier NCT 03155984). | - |
dc.language | eng | - |
dc.publisher | John Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/ | - |
dc.relation.ispartof | Hepatology | - |
dc.relation.ispartof | Liver Meeting, American Association for the Study of Liver Disease | - |
dc.rights | Hepatology. Copyright © John Wiley & Sons, Inc. | - |
dc.title | Feasibility of strategic monitoring in patients with prior HBV exposure undergoing anti-CD20 monoclonal antibody therapy: a prospective observational study | - |
dc.type | Conference_Paper | - |
dc.identifier.email | Seto, WKW: wkseto@hku.hk | - |
dc.identifier.email | Liu, SHK: drkliu@hku.hk | - |
dc.identifier.email | Cheung, KS: cks634@hku.hk | - |
dc.identifier.email | Fung, JYY: jfung@hkucc.hku.hk | - |
dc.identifier.email | Wong, DKH: danywong@hku.hk | - |
dc.identifier.email | Lai, CL: hrmelcl@hkucc.hku.hk | - |
dc.identifier.email | Yuen, RMF: mfyuen@hku.hk | - |
dc.identifier.authority | Seto, WKW=rp01659 | - |
dc.identifier.authority | Fung, JYY=rp00518 | - |
dc.identifier.authority | Wong, DKH=rp00492 | - |
dc.identifier.authority | Lai, CL=rp00314 | - |
dc.identifier.authority | Yuen, RMF=rp00479 | - |
dc.description.nature | abstract | - |
dc.identifier.hkuros | 285121 | - |
dc.identifier.hkuros | 293855 | - |
dc.identifier.hkuros | 292162 | - |
dc.identifier.volume | 66 | - |
dc.identifier.issue | 1, Suppl. 1 | - |
dc.identifier.spage | 1009A, abstract no. 1902 | - |
dc.identifier.epage | 1009A, abstract no. 1902 | - |
dc.identifier.isi | WOS:000412089802259 | - |
dc.publisher.place | United States | - |
dc.identifier.partofdoi | 10.1002/hep.29501 | - |
dc.identifier.issnl | 0270-9139 | - |