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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

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Improving testing for hepatitis B before treatment with rituximab.

Jessica K Dyson1, Laura Jopson, Sarah Ng

  • 1aLiver Unit, Freeman Hospital bDirectorate of Pharmacy cDepartment of Microbiology, Newcastle upon Tyne Hospitals NHS Foundation Trust dNIHR Biomedical Research Centre eInstitute of Cellular Medicine, Newcastle University fPublic Health Laboratory, Newcastle upon Tyne, UK.

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Implementing a hepatitis B virus (HBV) screening policy before rituximab treatment significantly increased testing rates. This universal screening identified patients needing antiviral prophylaxis to prevent dangerous HBV reactivation.

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Area of Science:

  • Immunology
  • Hepatology
  • Pharmacology

Background:

  • Immunosuppressive therapy, such as rituximab, poses a risk of hepatitis B virus (HBV) reactivation.
  • HBV reactivation can lead to severe hepatitis and increased mortality.
  • Universal HBV screening and prophylactic antiviral therapy are crucial for prevention.

Purpose of the Study:

  • To describe the implementation of a local policy for HBV testing prior to rituximab administration.
  • To assess the impact of this policy on HBV screening rates.
  • To evaluate the necessity of antiviral prophylaxis in patients receiving rituximab.

Main Methods:

  • A baseline review of HBV testing rates (HBsAg and anti-HBcAb) in patients before rituximab initiation.
  • Introduction of a local policy based on international guidelines, including improved laboratory reporting and education.
  • Post-policy reviews to measure changes in HBV testing rates.

Main Results:

  • Pre-policy, only 23% of patients were tested for HBsAg and 19% for anti-HBcAb.
  • Post-policy, testing rates increased significantly to 79% for HBsAg and 78% for anti-HBcAb.
  • During the study, 0.8% were HBsAg-positive and 4.7% were anti-HBcAb-positive, with 6% requiring prophylaxis.

Conclusions:

  • Simple strategies effectively improve HBV screening rates before rituximab treatment.
  • Universal screening is essential as a significant proportion requiring prophylaxis lacked recognized HBV risk factors.
  • Ongoing education and guideline reinforcement are necessary to maintain and further enhance testing rates.