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Scoring system for risk stratification of viral reactivation during prophylactic antiviral treatment in Korean patients with hepatitis B undergoing anticancer chemotherapy: A multicenter study

Title
Scoring system for risk stratification of viral reactivation during prophylactic antiviral treatment in Korean patients with hepatitis B undergoing anticancer chemotherapy: A multicenter study
Authors
Kim, Hwi YoungYoo, Jeong-JuOh, SoheeYu, Su JongKim, Yoon JunYoon, Jung-HwanKim, WonJung, Yong JinKim, Bo HyunKim, Chang-MinPark, Joong-WonLee, Jeong-Hoon
Ewha Authors
김휘영
SCOPUS Author ID
김휘영scopus
Issue Date
2018
Journal Title
JOURNAL OF MEDICAL VIROLOGY
ISSN
0146-6615JCR Link1096-9071JCR Link
Citation
vol. 90, no. 10, pp. 1593 - 1603
Keywords
antiviral agentshepatitis Bvirus reactivation
Publisher
WILEY
Indexed
SCI; SCIE; SCOPUS WOS scopus
Abstract
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.
DOI
10.1002/jmv.25241
Appears in Collections:
의과대학 > 의학과 > Journal papers
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