title: A drug safety evaluation of rituximab and risk of hepatitis B.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Washington University School of Medicine, Division of Oncology, Department of Medicine , 660 S. Euclid Ave, Campus Box 8056, St. Louis, MO 63110 , USA +1 314 362 0492 ; +1 314 747 5123 ; kcarson@dom.wustl.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Riedell
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Carson
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D006509:Hepatitis B / Q000139:chemically induced*; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D000069283:Rituximab
keywords: antiviral prophylaxis; hepatitis B; rituximab; screening