Z Gastroenterol 2009; 47 - P4_26
DOI: 10.1055/s-0029-1191945

Rituximab leads to reactivation of hepatitis B in individuals with resolved infection

F Metzler 1, I Mederacke 1, MP Manns 1, H Wedemeyer 1, K Wursthorn 1
  • 1Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover

Rituximab is an anti-CD20 antibody for the treatment of B-cell Non-Hodgkin Lymphoma (NHL) and Rheumatoid Arthritis (RA). The administration of rituximab can lead to reactivation of hepatitis B virus (HBV) infection in HBV carriers resulting in hepatic failure and death. Current guidelines recommend HBsAg testing and antiviral prophylaxis for hepatitis B carriers for a finite course. The aim of this study was to analyse the course of hepatitis B in patients with rituximab treatment.

A total of 709 courses of rituximab were given to 258 hospitalized patients at the Hannover Medical School in the years 2005 to 2007. The median age at the time of the first dose was 46 years. For 78 patients there were no records of testing for hepatitis. 83 individuals had been vaccinated either before or during the course of rituximab treatment. Titres of anti-HBs were found to drop over time. 21/258 patients were positive for anti-HBc, 20 of those were also positive for anti-HBs antibody with a resolved hepatitis B infection. 1 patient remained an inactive HBsAg carrier with detectable HBsAg, low HBV viremia at 1.1×103 IU/mL and normal ALT. Median follow-up of anti-HBc+ patients was 88 days with no data available for 7 patients after the last dose of rituximab. 3/20 patients with resolved HBV infection became HBV-DNA positive 92, 146 and 320 days after administration of 2 to 3 doses of rituximab. 2 of the 3 patients had protective anti-HBs antibodies prior to therapy and lost those to become HBsAg+. The third patient with HBV DNA recurrence remained anti-HBs and anti-HBc antibody positive. 2 patients developed ALT flares of up to 5x ULN. There was no HBV associated death.

Our results show that reactivation of hepatitis B can occur. Decline and subsequent loss of neutralizing anti-HBs antibodies and reappearance of HBV DNA in patients with resolved hepatitis B must be considered after rituximab administration. Testing for HBV DNA and serology should be performed on a regular basis.

hepatitis B immunosuppression rituximab reactivation