Interventions to Prevent HBV Reactivation in Anti-CD20 Treatment Recipients

Implementation of interventions to prevent hepatitis B virus (HBV) reactivation among patients in the Veterans Health Administration (VHA) receiving anticluster of differentiation antibody (anti-CD20 Ab) treatment increased national rates of HBV testing from 61% to >90% and increased antiviral prophylaxis from 17% to >80%, according to a retrospective study published in Hepatology Communications.¹

Patients with past or chronic HBV infection who receive high-risk immunosuppression, such as anti-CD20 Ab treatment, are at risk for HBV reactivation, which can result in hepatitis, liver failure, and even death.^2,3 One in 9 veterans receiving care in the VHA have serologic evidence of prior HBV exposure; however, only 61% to 73% of those who were receiving anti-CD20 Ab treatment underwent HBV testing and fewer than 20% of eligible patients received HBV antiviral prophylaxis, according to a study from 2014.⁴

Therefore, researchers sought to prevent HBV reactivation by increasing HBV testing and antiviral treatment rates among anti-CD20 Ab recipients through the development of various comprehensive prevention systems.¹ These prospective interventions involved national seminars, newsletters, websites; pharmacy requirements for HBV screening and treatment prior to anti-CD20 Ab use; changes to national formulary restrictions; a Medication Use Evaluation Tracker; e mails to all VHA oncology providers on specific testing and HBV antiviral treatment needs; and an electronic medical record order check to assess pretreatment HBV testing and antiviral treatment that generated a reminder to address deficiencies.

As a result of these interventions, pre-anti-CD20 Ab treatment HBV testing increased to 91% to 96% and appropriate HBV antiviral prophylaxis increased to 76% to 85%. Those centers that implemented the electronic medical record order check saw an increase in HBV testing rates to 93% to 98% and an increase in HBV antiviral prophylaxis rates to 99%.

“Multimodal intervention systems to prevent HBV reactivation among VHA patients receiving anti-CD20 Ab therapies increased national rates of HBV testing to >90% and antiviral prophylaxis to >80%,” concluded the study authors.¹

References

1. Bullard AJ, Cunningham FE, Volpp BD, et al. Preventing hepatitis B reactivation during anti-CD20 antibody treatment in the Veterans Health Administration. Hepatol Commun. 2018;2(9):1136-1146.
2. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:221-244.
3. Loomba R, Rowley A, Wesley R, et al. Systematic review: the effect of preventive lamivudine on hepatitis B reactivation during chemotherapy. Ann Intern Med. 2008;148:519-528.
4. Hunt CM, Beste LA, Lowy E, et al. Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration. World J Gastroenterol. 2016;22:4732-4740.