Immunosuppressives and anticancer drugs may reactivate Hepatitis B virus (HBV)

the Oncology Nurse Advisor take:

Chemotherapy or immunosuppressive treatment may reactive hepatitis B virus in patients previously infected with the virus.

Authors of a report presented at the Emerging Trends Conference suggest routine screening of HBV in all patients prior to initiating treatment with anticancer drugs or immunosuppressives. An FDA Drug Safety Communication identified ofatumumab (Arzerra) and rituximab (Rituxan) as two drugs in which risk of HBV reactivation may be a concern.

The drugs are monoclonal antibodies that target the protein CD20 used to treat autoimmune diseases, leukemia, lymphoma, and transplant rejection. HBV infection is detected by the presence of hepatitis B surface antigen (HBsAg) circulating in the blood.

All patients develop antibodies to the virus that remain after HBsAg clearance, indicating a potential for reactivation of the disease.

Experts are unclear about how HBV reactivation occurs but believe a loss of immune control may trigger the reactivation process. HBV reactivation can be severe; it may cause acute liver failure and even death.

These researchers conclude that the risk of HBV reactivation may extend beyond the use of the two anti-CD20 medications. Further study is needed to help broaden understanding of HBV reactivation.