Scoring system for risk stratification of viral reactivation during prophylactic antiviral treatment in Korean patients with hepatitis B undergoing anticancer chemotherapy: A multicenter study
- 주제(키워드) antiviral agents , hepatitis B , virus reactivation
- 주제(기타) Virology
- 설명문(일반) [Kim, Hwi Young] Ewha Womans Univ, Coll Med, Dept Internal Med, Seoul, South Korea; [Yoo, Jeong-Ju] Soonchunhyang Univ, Dept Internal Med, Div Gastroenterol & Hepatol, Bucheon Hosp, Bucheon, South Korea; [Oh, Sohee] Seoul Natl Univ, Boramae Med Ctr, Seoul Metropolitan Govt, Dept Biostat, Seoul, South Korea; [Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan; Lee, Jeong-Hoon] Seoul Natl Univ, Seoul Natl Univ Hosp, Dept Internal Med, Coll Med, 101 Daehak Ro, Seoul 03080, South Korea; [Kim, Won; Jung, Yong Jin] Seoul Natl Univ, Boramae Med Ctr, Seoul Metropolitan Govt, Dept Internal Med, Seoul, South Korea; [Kim, Bo Hyun; Kim, Chang-Min; Park, Joong-Won] Natl Canc Ctr, Ctr Liver Canc, Res Inst & Hosp, 323 Ilsan Ro, Goyang 10408, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 WILEY
- 발행년도 2018
- URI http://www.dcollection.net/handler/ewha/000000156816
- 본문언어 영어
- Published As http://dx.doi.org/10.1002/jmv.25241
초록/요약
Prophylactic antiviral therapy is recommended for hepatitis B virus (HBV)-infected patients with malignancies who are undergoing systemic chemotherapy. In the current study, we aimed to develop a risk scoring system to guide the selection of prophylactic antiviral agents. In this retrospective analysis, we included consecutive chronic hepatitis B patients who received antiviral prophylaxis for chemotherapy of solid or hematologic malignancies at three large-volume hospitals in Korea. The primary endpoint was HBV reactivation. The inverse probability treatment weighting method was used to minimize selection bias in terms of antiviral assignments. A total of 419 patients were enrolled: 129 patients received lamivudine (LAM), 216 received telbivudine (LdT), and 74 received entecavir (ETV), respectively. Of these, 36 patients developed on-treatment HBV reactivation (LAM, 17; LdT, 18; ETV, 1). Multivariate analysis identified three independent predictors for reactivation: hepatitis B e-antigen positivity, HBV DNA level, and type of malignancy. Accordingly, a risk scoring system was developed wherein one point was assigned for each of the risk factors. HBV reactivation occurred more frequently in the high-risk group (score 2) than in the low-risk group (hazards ratio, 14.17; P < 0.001). ETV exhibited superior prophylactic efficacy over LdT or LAM in the high-risk group, whereas no significant difference was noted in the low-risk group. The prognostic scoring system was useful for risk stratification of chemotherapy-related HBV reactivation. High genetic barrier agents appear to be vital for high-risk patients, whereas cost-effectiveness may be more relevant for low-risk patients.
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