The awareness of physicians using biological agents in treatment about hepatitis B virus reactivation.
Abstract
Objective: As long as immunosuppressive treatments are widely used, careful monitoring of HBVr is essential. We aimed to measure the awareness of Turkish physicians of certain specialties about the risk of hepatitis B virus reactivation (HBVr), HBV screening methods, prophylactic treatment practices and personal experiences in treating patients with biological agents.
Methods: An electronic questionnaire link containing 21 questions about demographics and their applications to HBVr was sent to participants working in the various specialties across the country.
Results: 227 participants took our survey (Female: 52.4%, n:119, Male: 47.6%, n:108), and consisted of 70 Hematologists, 65 Rheumatologists, 38 Gastroenterologists, 33 Oncologists, and 21 Dermatologists. We obtained extremely different results. It was found that all specialties are aware that the use of biological agents can cause HBVr (97.8%, n:222/227). Biological agents were used in 96% of the participants and HBVr was detected in 53.7% (Hematologist: 74.3%, Rheumatologist: 53.8%, Oncologist: 45.5%, Gastroenterologist: 44.7%, Dermatologist: 14.3%, p< 0.001). The general opinion was that, screening tests should be used (Gastroenterologist: 47.4%, p< 0.001) and 55.1% awared of how to monitor HBVr (Gastroenterologist: 65.8%, p = 0.06). The duration of antiviral prophylaxis was answered correctly in 70.4% (Hematologist: 82.6%, p = 0.01), the parameters of screening tests in 95.2% (Gastroenterologist: 97.4%, p = 0.52) and the highest risk of reactivation in 93% (Rheumatologist: 96.9%, p = 0.15) and the agent with the highest risk of reactivation in 82.8% of participants (Hematologist: 94.3%, p< 0.001).
Conclusion: The opinions of different the clinical disciplines vary according to the profile of patients. Gastroenterologists' perspective on HBVr follow-up and treatment differs markedly from that of other clinical disciplines. However, to create general awareness and manage HBVr, guidelines for specific patient groups are definitely needed.
Keywords
hepatitis B virus reactivation prophylaxis clinical practice clinical awareness online forum biological agents
References
- 1. World Health Organization. Guidelines for the Prevention, Care, and Treatment of Per- sons with Chronic Hepatitis B Infection. Geneva: WHO press; 2015.
- 2. Gentile G, Antonelli G. HBV Reactivation in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Narrative Review. Viruses. 2019; 11(1049):1-17. doi:10.3390/ v11111049
- 3. Özkan H. Epidemiology of Chronic Hepatitis B in Turkey. Euroasian J hepato-gastroen- terology. 2018; 8(1):73-74. doi:10.5005/jp-journals-10018-1264
- 4. Köse Ş, Mandıracıoğlu A, Çavdar G, et al. Seroprevalence of Hepatitis B and Hepatitis C: A Community Based Study Conducted in İzmir. Kafkas J Med Sci. 2013; 4(3):95-101. doi:10.5505/kjms.2014.21043
- 5. Yenilmez E, Cetinkaya RA. Overuse of prophylaxis in HBsAg and/or anti-HBc positive patients after increasing awareness to prevent reactivation in patients receiving immu- nosuppressive therapies: How rational are our prophylaxis decisions according to the literature? Le Infez Med. 2019; 27(3):299-307.
- 6. Pawłowska M, Flisiak R, Gil L, et al. Prophylaxis of hepatitis B virus (HBV) infection rea- ctivation - recommendations of the Working Group for prevention of HBV reactivation. Clin Exp Hepatol. 2019; 5(3):195-202. doi:10.5114/ceh.2019.87631
- 7. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015; 148(1):221-244.e3. do- i:10.1053/j.gastro.2014.10.038
- 8. Aygen B, Demir AM, Gümüş M, et al. Immunosuppressive therapy and the risk of he- patitis B reactivation: Consensus report. Turk J Gastroenterol. 2018; 29(3):259-269. doi:10.5152/tjg.2018.18263
- 9. Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009; 49(5 Suppl):S156-65. doi:10.1002/hep.22945
- 10. Hwang JP, Fisch MJ, Zhang H, et al. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract. 2012; 8(4):e32-9. doi:10.1200/JOP.2011.000450
- 11. Paul S, Shuja A, Tam I, et al. Gastroenterologists Have Suboptimal Hepatitis B Virus Screening Rates in Patients Receiving Immunosuppressive Therapy. Dig Dis Sci. 2016; 61(8):2236-2241. doi:10.1007/s10620-016-4118-1
- 12. Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015; 148(1):215-219; quiz e16-7. doi:10.1053/j.gastro.2014.10.039
- 13. Pietro K, Berg T, Buti M, et al. EASL 2017 Clinical Practice Guidelines on the mana- gement of hepatitis B virus infection. J Hepatol. 2017; 67(2):370-398. doi:10.1016/j. jhep.2017.03.021
- 14. Lau G, Yu ML, Wong G, et al. APASL clinical practice guideline on hepatitis B reactivati- on related to the use of immunosuppressive therapy. Hepatol Int. 2021; 15(5):1031-1048. doi: 10.1007/s12072-021-10239-x.
- 15. Khokhar OS, Farhadi A, McGrail L, et al. Oncologists and hepatitis B: a survey to deter- mine current level of awareness and practice of antiviral prophylaxis to prevent reactiva- tion. Chemotherapy. 2009; 55(2):69-75. doi:10.1159/000183731
- 16. Turker K, Oksuzoglu B, Balci E, et al. Awareness of hepatitis B virus reactivation among physicians authorized to prescribe chemotherapy. Eur J Intern Med. 2013; 24(8):e90-2. doi:10.1016/j.ejim.2013.07.008
- 17. Lee RSM, Bell CM, Singh JM, et al. Hepatitis B screening before chemotherapy: a sur- vey of practitioners’ knowledge, beliefs, and screening practices. J Oncol Pract. 2012; 8(6):325-328. doi:10.1200/JOP.2012.000597
- 18. Hwang JP, Fisch MJ, Lok AS-F, et al. Trends in hepatitis B virus screening at the on- set of chemotherapy in a large US cancer center. BMC Cancer. 2013; 13(534):1-11. doi:10.1186/1471-2407-13-534
- 19. Stine JG, Bass M, Ibrahim D, et al. Dermatologists’ awareness of and screening practices for hepatitis B virus infection before initiating tumor necrosis factor-α inhibitor therapy. South Med J. 2011; 104(12):781-788. doi:10.1097/SMJ.0b013e318238b608
- 20. Toka B, Eminler AT, Gönüllü E, et al. Rheumatologists’ awareness of hepatitis B reac- tivation before immunosuppressive therapy. Rheumatol Int. 2019; 39(12):2077-2085. doi:10.1007/s00296-019-04437-y
- 21. Stine JG, Khokhar OS, Charalambopoulos J, et al. Rheumatologists’ awareness of and screening practices for hepatitis B virus infection prior to initiating immunomodulatory therapy. Arthritis Care Res (Hoboken). 2010; 62(5):704-711. doi:10.1002/acr.20209
- 22. Marignani M, Marzano A, Begini P, et al. Perception of hepatitis B virus infection re- activation-related issues among specialists managing hematologic malignancies: result of an Italian survey. Leuk Lymphoma. 2014; 55(11):2564-2571. doi:10.3109/10428194. 2013.879712
- 23. Gül Yurtsever S, Küçükzeybek Y, Kaya S, ve ark. Medikal onkoloji hastalarında Hepatit B seroprevalansı. Nobel Med. 2020; 16(3):29-34.
- 24. Lok ASF, Ward JW, Perrillo RP, et al. Reactivation of hepatitis B during immunosuppres- sive therapy: potentially fatal yet preventable. Ann Intern Med. 2012; 156(10):743-745. doi:10.7326/0003-4819-156-10-201205150-00013
- 25. Hwang JP, Somerfield MR, Alston-Johnson DE, et al. Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provi- sional Clinical Opinion Update. J Clin Oncol. 2015; 33(19):2212-2220. doi:10.1200/ JCO.2015.61.3745
- 26. Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis. 2011; 11(337):1-12. doi:10.1186/1471-2334-11-337
- 27. Di Bisceglie AM, Lok AS, Martin P, et al. Recent US Food and Drug Administration war- nings on hepatitis B reactivation with immune-suppressing and anticancer drugs: just the tip of the iceberg? Hepatology. 2015; 61(2):703-711. doi:10.1002/hep.27609
Tedavide biyolojik ajanlar kullanan hekimlerin hepatit B virüs reaktivasyonu konusundaki farkındalıkları
Abstract
Amaç: İmmünsupresif tedaviler yaygın olarak kullanıldığı sürece, HBVr'nin dikkatle izlenmesi esastır. Belirli uzmanlık dallarındaki Türk hekimlerinin, hepatit B virüsü reaktivasyonu (HBVr) riski, HBV tarama yöntemleri, profilaktik tedavi uygulamaları ve biyolojik ajanlarla hasta tedavisindeki kişisel deneyimleri hakkındaki farkındalıklarını ölçmeyi amaçladık.
Metod: Ülke genelinde çeşitli uzmanlık alanlarında çalışan katılımcılara, demografik bilgiler ve bunların HBVr uygulamaları hakkında 21 soru içeren bir elektronik anket bağlantısı gönderildi.
Bulgular: Anketimize 70 Hematolog, 65 Romatolog, 38 Gastroenterolog, 33 Onkolog ve 21 Dermatolog olmak üzere toplam 227 kişi (Kadın: %52,4, n:119, Erkek: %47,6, n:108) katılmıştır. Son derece farklı sonuçlar elde ettik. Biyolojik ajan kullanımının HBVr'ye neden olabileceğinin tüm uzmanlık dallarınca bilindiği görüldü (%97,8, n:222/227). Katılımcıların %96'sı tedavide biyolojik ajan kullanılmış ve %53,7'si hastalarında HBVr saptanmıştır (Hematolog: %74,3, Romatolog: %53,8, Onkolog: %45,5, Gastroenterolog: %44,7, Dermatolog: %14,3, p< 0,001). Genel kanı tarama testlerinin kullanılması gerektiği (Gastroenterolog: %47,4, p< 0,001) ve %55,1'inin HBVr'nin nasıl izleneceğini bildiği (Gastroenterolog: %65,8, p= 0,06) yönündeydi. Katılımcılar tarafından, antiviral profilaksi süresi %70,4 (Hematolog: %82,6, p=0,01), tarama testlerinin parametreleri %95,2 (Gastroenterolog: %97,4, p=0,52), en yüksek reaktivasyon riski %93 ( Romatolog: %96,9, p=0,15) ve katılımcıların %82,8'inde reaktivasyon riski en yüksek ajan (Hematolog: %94,3, p< 0,001) doğru olarak yanıtlandı.
Sonuç: Farklı klinik disiplinlerin görüşleri hasta profiline göre değişmektedir. Gastroenterologların HBVr takibi ve tedavisine bakış açısı, diğer klinik disiplinlerden belirgin şekilde farklıdır. Bununla birlikte, genel farkındalık yaratmak ve HBVr'yi yönetmek için, belirli hasta gruplarına yönelik kılavuzlara kesinlikle ihtiyaç vardır.
Keywords
hepatitis B virus reactivation prophylaxis clinical practice clinical awareness online forum biological agents
References
- 1. World Health Organization. Guidelines for the Prevention, Care, and Treatment of Per- sons with Chronic Hepatitis B Infection. Geneva: WHO press; 2015.
- 2. Gentile G, Antonelli G. HBV Reactivation in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Narrative Review. Viruses. 2019; 11(1049):1-17. doi:10.3390/ v11111049
- 3. Özkan H. Epidemiology of Chronic Hepatitis B in Turkey. Euroasian J hepato-gastroen- terology. 2018; 8(1):73-74. doi:10.5005/jp-journals-10018-1264
- 4. Köse Ş, Mandıracıoğlu A, Çavdar G, et al. Seroprevalence of Hepatitis B and Hepatitis C: A Community Based Study Conducted in İzmir. Kafkas J Med Sci. 2013; 4(3):95-101. doi:10.5505/kjms.2014.21043
- 5. Yenilmez E, Cetinkaya RA. Overuse of prophylaxis in HBsAg and/or anti-HBc positive patients after increasing awareness to prevent reactivation in patients receiving immu- nosuppressive therapies: How rational are our prophylaxis decisions according to the literature? Le Infez Med. 2019; 27(3):299-307.
- 6. Pawłowska M, Flisiak R, Gil L, et al. Prophylaxis of hepatitis B virus (HBV) infection rea- ctivation - recommendations of the Working Group for prevention of HBV reactivation. Clin Exp Hepatol. 2019; 5(3):195-202. doi:10.5114/ceh.2019.87631
- 7. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015; 148(1):221-244.e3. do- i:10.1053/j.gastro.2014.10.038
- 8. Aygen B, Demir AM, Gümüş M, et al. Immunosuppressive therapy and the risk of he- patitis B reactivation: Consensus report. Turk J Gastroenterol. 2018; 29(3):259-269. doi:10.5152/tjg.2018.18263
- 9. Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009; 49(5 Suppl):S156-65. doi:10.1002/hep.22945
- 10. Hwang JP, Fisch MJ, Zhang H, et al. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract. 2012; 8(4):e32-9. doi:10.1200/JOP.2011.000450
- 11. Paul S, Shuja A, Tam I, et al. Gastroenterologists Have Suboptimal Hepatitis B Virus Screening Rates in Patients Receiving Immunosuppressive Therapy. Dig Dis Sci. 2016; 61(8):2236-2241. doi:10.1007/s10620-016-4118-1
- 12. Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015; 148(1):215-219; quiz e16-7. doi:10.1053/j.gastro.2014.10.039
- 13. Pietro K, Berg T, Buti M, et al. EASL 2017 Clinical Practice Guidelines on the mana- gement of hepatitis B virus infection. J Hepatol. 2017; 67(2):370-398. doi:10.1016/j. jhep.2017.03.021
- 14. Lau G, Yu ML, Wong G, et al. APASL clinical practice guideline on hepatitis B reactivati- on related to the use of immunosuppressive therapy. Hepatol Int. 2021; 15(5):1031-1048. doi: 10.1007/s12072-021-10239-x.
- 15. Khokhar OS, Farhadi A, McGrail L, et al. Oncologists and hepatitis B: a survey to deter- mine current level of awareness and practice of antiviral prophylaxis to prevent reactiva- tion. Chemotherapy. 2009; 55(2):69-75. doi:10.1159/000183731
- 16. Turker K, Oksuzoglu B, Balci E, et al. Awareness of hepatitis B virus reactivation among physicians authorized to prescribe chemotherapy. Eur J Intern Med. 2013; 24(8):e90-2. doi:10.1016/j.ejim.2013.07.008
- 17. Lee RSM, Bell CM, Singh JM, et al. Hepatitis B screening before chemotherapy: a sur- vey of practitioners’ knowledge, beliefs, and screening practices. J Oncol Pract. 2012; 8(6):325-328. doi:10.1200/JOP.2012.000597
- 18. Hwang JP, Fisch MJ, Lok AS-F, et al. Trends in hepatitis B virus screening at the on- set of chemotherapy in a large US cancer center. BMC Cancer. 2013; 13(534):1-11. doi:10.1186/1471-2407-13-534
- 19. Stine JG, Bass M, Ibrahim D, et al. Dermatologists’ awareness of and screening practices for hepatitis B virus infection before initiating tumor necrosis factor-α inhibitor therapy. South Med J. 2011; 104(12):781-788. doi:10.1097/SMJ.0b013e318238b608
- 20. Toka B, Eminler AT, Gönüllü E, et al. Rheumatologists’ awareness of hepatitis B reac- tivation before immunosuppressive therapy. Rheumatol Int. 2019; 39(12):2077-2085. doi:10.1007/s00296-019-04437-y
- 21. Stine JG, Khokhar OS, Charalambopoulos J, et al. Rheumatologists’ awareness of and screening practices for hepatitis B virus infection prior to initiating immunomodulatory therapy. Arthritis Care Res (Hoboken). 2010; 62(5):704-711. doi:10.1002/acr.20209
- 22. Marignani M, Marzano A, Begini P, et al. Perception of hepatitis B virus infection re- activation-related issues among specialists managing hematologic malignancies: result of an Italian survey. Leuk Lymphoma. 2014; 55(11):2564-2571. doi:10.3109/10428194. 2013.879712
- 23. Gül Yurtsever S, Küçükzeybek Y, Kaya S, ve ark. Medikal onkoloji hastalarında Hepatit B seroprevalansı. Nobel Med. 2020; 16(3):29-34.
- 24. Lok ASF, Ward JW, Perrillo RP, et al. Reactivation of hepatitis B during immunosuppres- sive therapy: potentially fatal yet preventable. Ann Intern Med. 2012; 156(10):743-745. doi:10.7326/0003-4819-156-10-201205150-00013
- 25. Hwang JP, Somerfield MR, Alston-Johnson DE, et al. Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provi- sional Clinical Opinion Update. J Clin Oncol. 2015; 33(19):2212-2220. doi:10.1200/ JCO.2015.61.3745
- 26. Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis. 2011; 11(337):1-12. doi:10.1186/1471-2334-11-337
- 27. Di Bisceglie AM, Lok AS, Martin P, et al. Recent US Food and Drug Administration war- nings on hepatitis B reactivation with immune-suppressing and anticancer drugs: just the tip of the iceberg? Hepatology. 2015; 61(2):703-711. doi:10.1002/hep.27609
Details
| Primary Language | English |
|---|---|
| Subjects | Medical Microbiology |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | May 10, 2023 |
| Publication Date | April 30, 2023 |
| Acceptance Date | January 29, 2023 |
| Published in Issue | Year 2023 Volume: 7 Issue: 1 |
Cite
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