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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

TitleFeasibility of strategic monitoring in patients with prior HBV exposure undergoing anti-CD20 monoclonal antibody therapy: a prospective observational study
Authors
Issue Date2017
PublisherJohn 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?
AbstractBackground: 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).
DescriptionPoster presentation
Persistent Identifierhttp://hdl.handle.net/10722/253585
ISSN
2019 Impact Factor: 14.679
2015 SCImago Journal Rankings: 4.752
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSeto, WKW-
dc.contributor.authorMak, LY-
dc.contributor.authorLiu, SHK-
dc.contributor.authorCheung, KS-
dc.contributor.authorFung, JYY-
dc.contributor.authorWong, DKH-
dc.contributor.authorLai, CL-
dc.contributor.authorYuen, RMF-
dc.date.accessioned2018-05-21T02:59:59Z-
dc.date.available2018-05-21T02:59:59Z-
dc.date.issued2017-
dc.identifier.citationThe 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.issn0270-9139-
dc.identifier.urihttp://hdl.handle.net/10722/253585-
dc.descriptionPoster presentation-
dc.description.abstractBackground: 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.languageeng-
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/-
dc.relation.ispartofHepatology-
dc.relation.ispartofLiver Meeting, American Association for the Study of Liver Disease-
dc.rightsHepatology. Copyright © John Wiley & Sons, Inc.-
dc.titleFeasibility of strategic monitoring in patients with prior HBV exposure undergoing anti-CD20 monoclonal antibody therapy: a prospective observational study-
dc.typeConference_Paper-
dc.identifier.emailSeto, WKW: wkseto@hku.hk-
dc.identifier.emailLiu, SHK: drkliu@hku.hk-
dc.identifier.emailCheung, KS: cks634@hku.hk-
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hk-
dc.identifier.emailWong, DKH: danywong@hku.hk-
dc.identifier.emailLai, CL: hrmelcl@hkucc.hku.hk-
dc.identifier.emailYuen, RMF: mfyuen@hku.hk-
dc.identifier.authoritySeto, WKW=rp01659-
dc.identifier.authorityFung, JYY=rp00518-
dc.identifier.authorityWong, DKH=rp00492-
dc.identifier.authorityLai, CL=rp00314-
dc.identifier.authorityYuen, RMF=rp00479-
dc.identifier.hkuros285121-
dc.identifier.hkuros293855-
dc.identifier.hkuros292162-
dc.identifier.volume66-
dc.identifier.issue1, Suppl. 1-
dc.identifier.spage1009A, abstract no. 1902-
dc.identifier.epage1009A, abstract no. 1902-
dc.identifier.isiWOS:000412089802259-
dc.publisher.placeUnited States-

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