2015 American Gastroenterological Association Guidelines on the Risk for and Prevention of Hepatitis B Virus (HBV) Reactivation, by Immunosuppressive Agent and HBV Surface Antigen (HBsAg) and Antibody to HBV Core Antigen (Anti-HBc) Status
| Immunosuppressant Type(s) . | Agent(s) . | HBsAg-Positive, Anti-HBc–Positive Patients . | HBsAg-Negative, Anti-HBc–Positive Patients . | ||
|---|---|---|---|---|---|
| Reactivation Risk . | Recommendations . | Reactivation Risk . | Recommendations . | ||
| B-cell–depleting agents | Rituximab, ofatumumab | High | Prophylaxis | High | Prophylaxis |
| Anthracycline derivatives | Doxorubicin, epirubicin | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| TNF-α inhibitors | Etanercept, adalimumab, certolizumab, infliximab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Cytokine inhibitors and integrin inhibitors | Abatacept, ustekinumab, natalizumab, vedolizumab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Tyrosine kinase inhibitors | Imatinib, nilotinib | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Corticosteroids | |||||
| Duration, ≥4 wk | |||||
| Moderate/high dose | … | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| Low dose | … | Moderate | Prophylaxis or close monitoring | Low | Usual care |
| Duration, ≤1 wk | … | Low | Usual care | Low | Usual care |
| Traditional immunosuppressants | Azathioprine, 6-mercaptopurine, methotrexate | Low | Usual care | Low | Usual care |
| Immunosuppressant Type(s) . | Agent(s) . | HBsAg-Positive, Anti-HBc–Positive Patients . | HBsAg-Negative, Anti-HBc–Positive Patients . | ||
|---|---|---|---|---|---|
| Reactivation Risk . | Recommendations . | Reactivation Risk . | Recommendations . | ||
| B-cell–depleting agents | Rituximab, ofatumumab | High | Prophylaxis | High | Prophylaxis |
| Anthracycline derivatives | Doxorubicin, epirubicin | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| TNF-α inhibitors | Etanercept, adalimumab, certolizumab, infliximab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Cytokine inhibitors and integrin inhibitors | Abatacept, ustekinumab, natalizumab, vedolizumab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Tyrosine kinase inhibitors | Imatinib, nilotinib | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Corticosteroids | |||||
| Duration, ≥4 wk | |||||
| Moderate/high dose | … | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| Low dose | … | Moderate | Prophylaxis or close monitoring | Low | Usual care |
| Duration, ≤1 wk | … | Low | Usual care | Low | Usual care |
| Traditional immunosuppressants | Azathioprine, 6-mercaptopurine, methotrexate | Low | Usual care | Low | Usual care |
Data are from [34].
aTotal daily dose of prednisone (or equivalent): low dose, <10 mg; moderate dose, 10–20 mg; high dose, >20 mg.
2015 American Gastroenterological Association Guidelines on the Risk for and Prevention of Hepatitis B Virus (HBV) Reactivation, by Immunosuppressive Agent and HBV Surface Antigen (HBsAg) and Antibody to HBV Core Antigen (Anti-HBc) Status
| Immunosuppressant Type(s) . | Agent(s) . | HBsAg-Positive, Anti-HBc–Positive Patients . | HBsAg-Negative, Anti-HBc–Positive Patients . | ||
|---|---|---|---|---|---|
| Reactivation Risk . | Recommendations . | Reactivation Risk . | Recommendations . | ||
| B-cell–depleting agents | Rituximab, ofatumumab | High | Prophylaxis | High | Prophylaxis |
| Anthracycline derivatives | Doxorubicin, epirubicin | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| TNF-α inhibitors | Etanercept, adalimumab, certolizumab, infliximab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Cytokine inhibitors and integrin inhibitors | Abatacept, ustekinumab, natalizumab, vedolizumab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Tyrosine kinase inhibitors | Imatinib, nilotinib | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Corticosteroids | |||||
| Duration, ≥4 wk | |||||
| Moderate/high dose | … | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| Low dose | … | Moderate | Prophylaxis or close monitoring | Low | Usual care |
| Duration, ≤1 wk | … | Low | Usual care | Low | Usual care |
| Traditional immunosuppressants | Azathioprine, 6-mercaptopurine, methotrexate | Low | Usual care | Low | Usual care |
| Immunosuppressant Type(s) . | Agent(s) . | HBsAg-Positive, Anti-HBc–Positive Patients . | HBsAg-Negative, Anti-HBc–Positive Patients . | ||
|---|---|---|---|---|---|
| Reactivation Risk . | Recommendations . | Reactivation Risk . | Recommendations . | ||
| B-cell–depleting agents | Rituximab, ofatumumab | High | Prophylaxis | High | Prophylaxis |
| Anthracycline derivatives | Doxorubicin, epirubicin | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| TNF-α inhibitors | Etanercept, adalimumab, certolizumab, infliximab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Cytokine inhibitors and integrin inhibitors | Abatacept, ustekinumab, natalizumab, vedolizumab | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Tyrosine kinase inhibitors | Imatinib, nilotinib | Moderate | Prophylaxis or close monitoring | Moderate | Prophylaxis or close monitoring |
| Corticosteroids | |||||
| Duration, ≥4 wk | |||||
| Moderate/high dose | … | High | Prophylaxis | Moderate | Prophylaxis or close monitoring |
| Low dose | … | Moderate | Prophylaxis or close monitoring | Low | Usual care |
| Duration, ≤1 wk | … | Low | Usual care | Low | Usual care |
| Traditional immunosuppressants | Azathioprine, 6-mercaptopurine, methotrexate | Low | Usual care | Low | Usual care |
Data are from [34].
aTotal daily dose of prednisone (or equivalent): low dose, <10 mg; moderate dose, 10–20 mg; high dose, >20 mg.
This PDF is available to Subscribers Only
View Article Abstract & Purchase OptionsFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
