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Prevention of hepatitis B virus reactivation in patients with hematological malignancies and resolved hepatitis B virus infection: a systematic review and meta‐analysis
Author(s) -
Cheung Carmen Ka Man,
Law Man Fai,
Chao David Chun,
Wong Sunny Hei,
Ho Rita,
Chao Amelia Chien Wei,
Lai Jennifer Wing Yan,
Chan Ted Yun Tat,
Tam Mark Tsz Kin,
Lau Sam Lik Fung,
Tam Tommy Ho Chi
Publication year - 2020
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12848
Subject(s) - medicine , hepatitis b virus , relative risk , meta analysis , hepatitis b , randomized controlled trial , rituximab , immunology , lymphoma , confidence interval , virus
Objective Patients with resolved hepatitis B virus (HBV) infection are at risk of HBV reactivation during treatment for hematological malignancies. We conducted a systematic review and meta‐analysis of the data on the efficacy of antiviral prophylaxis for the prevention of HBV reactivation in this group of patients. Methods We conducted a systemic literature search of PubMed including MEDLINE and EMBASE databases to 31 January 2019 to identify studies published in English comparing antiviral prophylaxis with no prophylaxis for HBV reactivation in patients treated for hematological malignancies. The search terms used were (“occult hepatitis B” OR “resolved hepatitis B”) AND (“reactivation”) AND (“haematological malignancy” OR “hematological malignancy” OR “chemotherapy” OR “immunotherapy” OR “chemoimmunotherapy” OR “lymphoma” OR “leukemia” OR “transplant”). The primary outcome was the reactivation of HBV infection. Pooled estimates of relative risk (RR) were calculated. Results We identified 13 relevant studies including two randomized controlled trials (RCT), one post hoc analysis from RCT and 10 cohort studies. There was a trend towards a lower rate of HBV reactivation using antiviral prophylaxis, but the difference was not significant (RR 0.57, 95% confidence interval [CI] 0.23–1.40, P = 0.22). When limiting the analysis to the three prospective studies of patients receiving anti‐CD20 monoclonal antibodies, we found antiviral prophylaxis was associated with a significantly lower risk of HBV reactivation (RR 0.17, 95% CI 0.06–0.49, P = 0.001). Conclusion Antiviral prophylaxis reduced the risk of HBV reactivation in patients receiving anti‐CD20 monoclonal antibodies for hematological malignancies but not in a broader group of patients receiving anticancer therapy.