title: Improvements in hepatitis B virus screening before rituximab therapy: A community-based, safety-net hospital experience.
abstract: Individuals with chronic hepatitis B virus infection (HBV) or previously resolved HBV are at increased risk of HBV exacerbation or reactivation when they receive treatment with anti-CD20 monoclonal antibodies (against B-lymphocyte antigen cluster of differentiation 20 [CD20], an activated-glycosylated phosphoprotein) like rituximab (RTX). The objective of the current study was to evaluate the rates of appropriate HBV screening before patients started receiving RTX, at the initiation of HBV treatment, and during HBV flares among an underserved safety-net population.
  
  
  
  In total, 244 consecutive adults who received treatment with RTX from 2006 to 2015 at an urban safety-net hospital were evaluated to determine appropriate HBV screening (HBV surface antigen [HBsAg] and HBV total core antibody [HBcAb]) before starting RTX. The initiation of prophylactic antiviral therapy and the development of HBV flares after starting RTX were evaluated. Predictors of appropriate HBV screening were evaluated using multivariate logistic regression models.
  
  
  
  Most patients were women (52.7%; n = 128) and of Hispanic ethnicity (30.7%; n = 74). Before starting RTX, 60.5% (n = 147) of patients received appropriate HBV screening. The HBV screening rates before RTX improved from 14.7% (2006-2009) to 74.7% (2010-2012), and to 87.1% (2013-2015; P < .01. Two of 7 (28.6%) HBsAg-positive patients who did not receive antiviral therapy experienced HBV flares and 1 died, and 2 of 27 patients (7.4%) HBcAb-positive/HBsAg-negative patients who did not receive antiviral therapy experienced HBV reactivation. No patient-specific or disease-specific predictors of receiving HBV screening before RTX therapy were identified.
  
  
  
  Among adults receiving RTX therapy in a single community-based hospital system, HBV screening rates were suboptimal, and 28.6% of HBsAg-positive patients and 7.4% of HBsAg-negative/HBcAb-positive patients who did not receive antiviral treatment experienced HBV reactivation or flare. Cancer 2017;123:650-656. © 2016 American Cancer Society.
authors.affiliation: Touro University College of Osteopathic Medicine, Vallejo, California.
authors.forename: Kevin
authors.identifier: 0000-0001-8366-0597
authors.initials: K
authors.lastname: Junus
authors.affiliation: Department of Medicine, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Division of Hematology and Oncology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Priya
authors.initials: P
authors.lastname: Patel
authors.affiliation: Division of Hematology and Oncology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: David
authors.initials: D
authors.lastname: Irwin
authors.affiliation: Division of Hematology and Oncology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Yee
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D018951:Antigens, CD20 / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects / Q000473:pathology; D005006:Ethnicity; D005260:Female; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects* / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D000069283:Rituximab / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D000069283:Rituximab
keywords: HBV screening; antiviral therapy; hepatitis B virus (HBV) flare; immunosuppression; rituximab