title: Screening for viral hepatitis prior to rituximab chemotherapy.
abstract: In 2008, the CDC published guidelines recommending screening of all persons undergoing treatment with rituximab to identify persons at risk of hepatitis B virus (HBV) reactivation. We evaluated implementation of this recommendation in veterans, who are at increased risk of HBV, and determined characteristics of those screened. We also evaluated a control setting, rates of hepatitis C virus (HCV) screening among the same rituximab-treated patients. There are no guidelines that recommend HCV screening prior to initiation of rituximab. Medical records of patients receiving rituximab between January 2006 and December 2012 were reviewed according to two time periods: 2006-2008 (period 1, pre-guidelines) and 2009-2012 (period 2, post-guidelines). Patient demographics, concomitant chemotherapy regimen (protocol, dose, duration), treatment indication, risk factors for hepatitis infection (substance abuse, homelessness, human immunodeficiency virus (HIV)), and HBV/HCV screening status were documented. During the study period, 102 patients were treated with rituximab (49 in period 1 and 53 in period 2). During periods 1 and 2, 22 and 32 % of rituximab-treated patients were screened for HBV, respectively (p = 0.375). Treatment during 2009 was the only significant predictor of HBV screening in the adjusted model (p = 0.01). For HCV during periods 1 and 2, 22 and 21 % of patients were screened, respectively (p = 1.00). There were no significant predictors of HCV screening. Rates of screening for HBV among rituximab-treated patients were low, both before and after dissemination of guidelines recommending universal HBV screening of rituximab-treated patients.
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Leonard
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA. loveb@sccp.sc.edu.|Department of Research, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA. loveb@sccp.sc.edu.
authors.forename: B L
authors.identifier: http://orcid.org/0000-0002-9221-9143
authors.initials: BL
authors.lastname: Love
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA.|Department of Research, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Norris
authors.affiliation: Department of Gastroenterology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Siddiqui
authors.affiliation: Department of Oncology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.
authors.forename: M N
authors.initials: MN
authors.lastname: Wallam
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, CLS 311, Columbia, SC, 29208, USA.|Department of Research, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.|Department of Oncology, William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, SC, 29208, USA.|South Carolina Center of Economic Excellence for Medication Safety and Efficacy, Columbia, SC, 29208, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy*; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000494:pharmacology / Q000627:therapeutic use*; D014775:Virus Activation / Q000187:drug effects / Q000502:physiology
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Chemotherapy; Drug therapy; Hepatitis B virus; Hepatitis C virus; Reactivation; Rituximab; Viral hepatitis