Spinicci Michele, Emmi Giacomo, Dies Laura, Barilaro Alessandro, Vitiello Gianfranco, Mencarini Jessica, Cavallo Annalisa, Bartoloni Alessandro, Bartalesi Filippo
Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze.
SOD Neurologia 2.
Eur J Gastroenterol Hepatol. 2018 Jul;30(7):756-760. doi: 10.1097/MEG.0000000000001132.
Rituximab (RTX) is a monoclonal antibody that is widely used in hematologic malignancies and immune-mediated diseases (IMID) and has been associated with the risk of hepatitis B virus reactivation (HBVr). Thus, antiviral prophylaxis is recommended before RTX treatment in all patients with chronic hepatitis B virus (HBV) infection and those with resolved infection affected by onco-hematological conditions. By contrast, the correct management of HBsAg-negative/HbcAb-positive patients candidates for RTX-containing regimens for IMID is still debated, owing to few data currently available in this setting.
We retrospectively evaluated the risk of HBVr in patients with IMID with resolved HBV infection, referred to the Infectious and Tropical Diseases Unit Outpatients Service, Careggi Hospital, Florence, Italy, between September 2013 and September 2017, undergoing RTX without antiviral prophylaxis and followed up by serial serum HBV-DNA monitoring.
Overall, 20 patients with IMID were identified (70% female, with median age of 57 years) and followed up for a median period of 19 months (range: 2-36 months). A single HBVr case, detected in preclinical stage, was observed (1/20, 5%), and targeted prophylaxis was promptly introduced.
The results supported the low to moderate risk of HBVr in HBsAg-negative/HBcAb-positive patients with IMID undergoing RTX, in contrast to what is observed in onco-hematological settings. The targeted prophylaxis strategy, based on serum HBV-DNA serial monitoring, seems a safe option in these patients.
利妥昔单抗（RTX）是一种单克隆抗体，广泛应用于血液系统恶性肿瘤和免疫介导疾病（IMID），且与乙型肝炎病毒再激活（HBVr）风险相关。因此，建议在对所有慢性乙型肝炎病毒（HBV）感染患者以及受肿瘤血液学疾病影响的已治愈感染患者进行RTX治疗前进行抗病毒预防。相比之下，对于接受含RTX方案治疗IMID的HBsAg阴性/HbcAb阳性患者的正确管理仍存在争议，因为目前在这种情况下可用的数据较少。
我们回顾性评估了2013年9月至2017年9月期间转诊至意大利佛罗伦萨卡雷吉医院传染病和热带病科门诊、接受RTX治疗且未进行抗病毒预防并通过连续血清HBV-DNA监测进行随访的已治愈HBV感染的IMID患者的HBVr风险。
总体而言，共确定了20例IMID患者（70%为女性，中位年龄57岁），中位随访期为19个月（范围：2 - 36个月）。观察到1例在临床前阶段检测到的HBVr病例（1/20，5%），并立即采取了针对性预防措施。
结果支持接受RTX治疗的HBsAg阴性/HBcAb阳性IMID患者的HBVr风险为低至中度，这与肿瘤血液学环境中观察到的情况不同。基于血清HBV-DNA连续监测的针对性预防策略在这些患者中似乎是一种安全的选择。
