Doctors need to be aware of the risk of hepatitis B reactivation among patients treated with immunosuppressive drugs, according to a new guideline.
The guidance has been prepared by the American Gastroenterological Association, who recommend preventative antiviral treatment for patients at high risk of reactivation of the virus, which may include patients being treated for blood cancers and other blood disorders.
The gastroenterologists, who include experts from Singapore and Peru, say they are getting a growing number of referrals of patients with hepatitis B reactivation following treatment with immunosuppressive drugs.
Their guidance identifies a number of patients at high risk, including those receiving B-cell depleting agents such as rituximab, and CAR-T cell therapy. Those at increased risk may also include patients receiving medication following a bone marrow transplant.
The guidance has been published in the journal Gastroenterology.
The authors write: “This clinical practice guideline update aims to inform frontline health care practitioners by providing evidence-based practice recommendation for the management of hepatitis B viral reactivation in at-risk individuals.
“Reactivated HBV can lead to liver damage, hospitalization, and even death. These risks are higher than any potential side effects of antiviral medicines. For at-risk patients who do not initiate prophylactic antiviral medication, a commitment to close monitoring by both patients and providers is essential to prevent missed reactivation.”
Source:
Ali FS, Nguyen MH, Hernaez R, Huang DQ, Wilder J, Piscoya A, Simon TG, Falck-Ytter T (2025) “AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals.” Gastroenterology, February 2025, doi: 10.1053/j.gastro.2024.11.008
Link: https://www.gastrojournal.org/article/S0016-5085(24)05744-5/fulltext
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