A drug safety evaluation of rituximab and risk of hepatitis B. (July 2014)

• Record Type: Journal Article
• Authors: Riedell, Peter; Carson, Kenneth R
• Is Part Of: Expert opinion on drug safety. Volume 13:Number 7(2014)
• Page Start: 977
• Page End: 987
• Publication Date: 2014-07
• Subjects: antiviral prophylaxis -- hepatitis B -- rituximab -- screening; Drugs -- Side effects -- Periodicals; Drugs -- Toxicology -- Periodicals; Chemotherapy -- Periodicals; 615.704
• DOI: 10.1517/14740338.2014.918948
• Languages: English
• ISSNs: 1474-0338

Abstract

Abstract : Introduction: Rituximab is a widely prescribed anti-CD20 mAb for the treatment of CD20 + B-cell non-Hodgkin Lymphoma and many other immune mediated conditions. There is a well-described association between rituximab containing chemo-immunotherapy treatment and reactivation of the hepatitis B virus (HBV). This review summarizes the current literature surrounding rituximab-associated HBV reactivation. Areas covered: Herein, we review the literature detailing the risk of HBV reactivation in inactive carriers and those with resolved hepatitis. The clinical presentation and management of HBV reactivation are also discussed along with a summary of clinical trials evaluating antiviral prophylaxis. Finally, clinical recommendations are detailed. Data from clinical trials, observational studies, reviews, and meta-analyses available in the Medline database were included in this narrative review. Expert opinion: Screening should be performed in all patients prior to the administration of any type of anti-CD20 mAb therapy. Among those with positive screening serology, testing for hepatitis B e antigen or viral load by polymerase chain reaction is appropriate. In those patients with detectable HBV DNA, the decision regarding the use of antiviral prophylaxis or observation should be individualized.