Post-screening actions were recorded as none or use of a NA

Post-screening actions were recorded as none or use of a NA. antigen (HbsAg?)/anti-HBc+. Conclusions In those treated with rituximab, we demonstrated near-universal anti-HBc screening. Screening unlinked to preventive NA use, in those who are anti-HBc+, is ineffective in reducing HBr. HBr has a high fatality rate. The majority of cases occurred in those who were HBsAg negative. Efforts are needed to educate providers who use rituximab not only to screen for anti-HBc, but to provide preventive NA to those who test positive. strong class=”kwd-title” Keywords: hepatobiliary disease, preventive medicine, adverse events, gastrointestinal infections, health & safety, protocols & guidelines Strengths and limitations of this study Large, retrospective study evaluating the trends of screening over more than a decade. Observational data on real-life practices and effect of screening. Limited generalisability as this was a single-centre study. Unable to assess perceptions or reasons for screening trends. Introduction Rituximab therapy poses six times higher odds of hepatitis B reactivation (HBr) compared with chemotherapy regimens that do not contain rituximab in susceptible individuals.1 The estimated risk of HBr, with rituximab therapy, in patients with hepatitis B surface antigen (HBsAg) positive is 30%C60%?and in patients with HBsAg DUBs-IN-2 negative and hepatitis B core antibody (anti-HBc) positive is greater than 10%.2 With the use of a nucleoside analogue (NA), HBr can be prevented by 79%C100%.3 The NAs, entecavir and tenofovir are considered superior to lamivudine since they are more potent and have lower rates of resistance.3 4 In 2008, the Center for Disease Control and Prevention (CDC) recommended screening for hepatitis B in patients undergoing treatment with rituximab and in 2013 the Federal Drug Administration (FDA) issued a black box warning to screen for hepatitis B before initial treatment and to monitor for symptoms during and after treatment.1 5 6 Over the last decade, the recommendations regarding HBr in patients receiving rituximab have evolved. The American Association for the Study of Liver Disease (AASLD) first mentioned the risk of rituximab related HBr in their 2007 guidelines.7 Routine prophylaxis was recommended in patients with HBsAg+ but?not in patients with DUBs-IN-2 HBsAg?/anti-HBc+.7 Similarly, in 2009 2009, the European Association for the Study of the Liver (EASL) recommended screening for hepatitis B and recommended preventive NA therapy in patients with chronic hepatitis B virus (HBV) (HBsAg+/anti-HBc+) till 12 months after cessation of rituximab.8 In contrast, the American Society of Clinical Oncology (ASCO) published a Provisional Clinical Opinion in 2010 2010 concerning the CDCs 2008 DUBs-IN-2 recommendations.9 In ASCOs opinion, there was insufficient evidence assisting the CDC recommendations to display the general population for HBV prior to initiating therapy with rituximab and experienced that the consequences of screening and its economic implications had not been fully regarded as.9 Instead, ASCO recommended screening based on clinical judgement and estimated risk of HBV.9 A discretionary recommendation was issued to use NA prophylaxis in patients with chronic HBV since there was a dearth of evidence to support it.9 In 2015, the American Gastroenterological Association highlighted the increased risk of HBr, not only in patients who have been HBsAg+ but HBsAg?/anti-HBc+, and recommended NA prophylaxis in both of the above populations while receiving rituximab therapy.2 This was followed by an updated opinion by ASCO in 2015, that recommended common testing for HBV receiving immunosuppressive therapies and recommended the use of prophylactic NA therapy.10 Management of patients with HBsAg?/anti-HBc+ has been ambiguous. In Itga11 2012, EASL was one of the first associations to fine detail the management.