Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration.

dc.contributor.author

Hunt, CM

dc.coverage.spatial

United States

dc.date.accessioned

2016-05-01T22:27:19Z

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2016-05-21

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AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement. METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ(2) test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group. RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628/8110) likely prior HBV vaccination, and 76% (6022/7903) were HBV negative. In those with chronic HBV infection, ≤ 37% received HBV antiviral treatment during the high risk period while 21% to 23% of those with past or resolved HBV, respectively, received HBV antiviral treatment. During and 12 mo after anti-CD20 Ab, the rate of hepatitis was significantly greater in those HBV positive vs negative (P = 0.001). The mortality rate was 35%-40% in chronic or past hepatitis B and 26%-31% in hepatitis B negative. In those pretreatment HBV negative, 16 (0.3%) developed acute hepatitis B of 4947 tested during anti-CD20Ab treatment and follow-up. CONCLUSION: While HBV testing of Veterans has increased prior to anti-CD20 Ab, few HBV+ patients received HBV antivirals, suggesting electronic health record algorithms may enhance health outcomes.

dc.identifier

http://www.ncbi.nlm.nih.gov/pubmed/27217704

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2219-2840

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https://hdl.handle.net/10161/11950

dc.language

eng

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Baishideng Publishing Group Co. Limited

dc.relation.ispartof

World J Gastroenterol

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10.3748/wjg.v22.i19.4732

dc.subject

Anti-CD20 antibody

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Chemotherapy

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Hepatitis B

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Hepatitis B antivirals

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Hepatitis B reactivation

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Lymphoma

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Rituximab

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Vaccination

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Veteran

dc.title

Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration.

dc.type

Journal article

duke.contributor.orcid

Hunt, CM|0000-0002-6874-8889

pubs.author-url

http://www.ncbi.nlm.nih.gov/pubmed/27217704

pubs.begin-page

4732

pubs.end-page

4740

pubs.issue

19

pubs.organisational-group

Clinical Science Departments

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Duke

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Duke Cancer Institute

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Institutes and Centers

pubs.organisational-group

Medicine

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Medicine, Gastroenterology

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Medicine, Medical Oncology

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School of Medicine

pubs.publication-status

Published

pubs.volume

22

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