Open AccessPreventing Hepatitis B Reactivation During Anti‐CD20 Antibody Treatment in the Veterans Health Administration
Author(s) -
Jasmine Bullard A.,
Cunningham Francesca E.,
Volpp Bryan D.,
Lowy Elliott,
Beste Lauren A.,
Heron Bernadette B.,
Geraci Mark,
Hammond Julia M.,
LaPlant Kourtney,
Stave Elise A.,
Turner Marsha J.,
O’Leary Meghan C.,
Kelley Michael J.,
Hunt Christine M.
Publication year - 2018
Publication title -
hepatology communications
Language(s) - English
Resource type - Journals
ISSN - 2471-254X
DOI - 10.1002/hep4.1238
Subject(s) - medicine , hepatitis b virus , lamivudine , hepatitis b , pharmacy , psychological intervention , immunology , emergency medicine , family medicine , intensive care medicine , virus , nursing
Hepatitis B virus (HBV) reactivation may occur with high risk immunosuppression, such as anti‐cluster of differentiation (CD)20 antibodies (Abs). Appropriate HBV prophylaxis during anti‐CD20 Ab therapy averts hepatitis, chemotherapy disruption, and death. Serologic evidence of prior HBV exposure is present in one in nine veterans in the Veterans Health Administration (VHA). In 2014, most (61%‐73%) patients in the VHA who were receiving anti‐CD20 Ab treatment underwent HBV testing, yet <20% of eligible patients received HBV antiviral prophylaxis. We aimed to prevent HBV reactivation by increasing HBV testing and antiviral treatment rates among anti‐CD20 Ab recipients through prospective interventions. A multidisciplinary team of clinicians, pharmacists, and public health professionals developed comprehensive prevention systems, including national seminars/newsletters/websites; pharmacy criteria for HBV screening/treatment prior to anti‐CD20 Ab use; changes to national formulary restrictions to expand HBV prophylaxis prescribing authority; Medication Use Evaluation Tracker to identify omissions; national e‐mail alert to all VHA oncology providers detailing specific testing and HBV antiviral treatment needs; and a voluntary electronic medical record “order check” used at interested facilities (n = 11) to automatically assess pretreatment HBV testing and antiviral treatment and only generate a reminder to address deficiencies. Analysis of monthly data from June 2016 through September 2017 among anti‐CD20 Ab recipients revealed pre‐anti‐CD20 Ab treatment HBV testing increased to 91%‐96% and appropriate HBV antiviral prophylaxis to 76%‐85% nationally following implementation of the intervention. Medical centers using the voluntary electronic medical record order check increased HBV testing rates to 93%‐98% and HBV antiviral prophylaxis rates to 99%. Conclusion: 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%.