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Open Access 03-01-2024 | Hepatitis B | Intra-abdominal Infections, Hepatitis, and Gastroenteritis (T Steiner, Section Editor)

HBV Reactivation in Patients Receiving Bruton Tyrosine Kinase Inhibitors (BTKIs): a Systematic Review and Meta-Analysis

Authors: Ahmed Azzam, Heba Khaled, Basem Osama Ashry, Sarah Mohamed Hussein, Manar Osama, Ameer Ahmed, Omar Yousef, Anees Hjazeen, Ahmed A. Allam, Gellan Alaa Mohamed Kamel

Published in: Current Infectious Disease Reports | Issue 1/2024

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Abstract

Purpose of Review

Bruton tyrosine kinase inhibitors (BTKIs) are immunosuppressive cancer therapies approved for the treatment of various mature B-cell malignancies. Hepatitis B virus reactivation (HBVr) is a known complication in patients with chronic or past HBV infection undergoing immunosuppressive chemotherapy. The present work aims to establish the correlation between HBVr and patients receiving BTKIs.

Recent Findings

This review included 18 studies. The overall incidence of HBVr was found to be 6.6% in patients with past HBV infections who received ibrutinib. Fourteen cases of HBVr were associated with ibrutinib (two occult hepatitis B infections and twelve past HBV infections). One case of HBV past infection was associated with zanubrutinib, and three cases were recorded for acalabrutinib (one chronic HBV and two past HBV). Most incidents occurred in males older than 60 years within the first year after initiating BTKIs. Three reported cases documented HBVr after discontinuing ibrutinib and zanubrutinib. Two deaths caused by HBVr in patients with past HBV infections were recorded (one for each of acalabrutinib and ibrutinib). Remarkably, HBV antiviral treatment normalized liver functions and eliminated serum HBV in most cases. It was reported that false negativity of HBsAg following reactivation occurred in two cases: one case was attributed to HBsAg escape mutations, and the other to the hook effect.

Summary

Our findings show that HBVr risk is intermediate in patients with past HBV infections who receive ibrutinib. Universal anti-HBV prophylaxis before initiating ibrutinib may be an option.
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Metadata
Title
HBV Reactivation in Patients Receiving Bruton Tyrosine Kinase Inhibitors (BTKIs): a Systematic Review and Meta-Analysis
Authors
Ahmed Azzam
Heba Khaled
Basem Osama Ashry
Sarah Mohamed Hussein
Manar Osama
Ameer Ahmed
Omar Yousef
Anees Hjazeen
Ahmed A. Allam
Gellan Alaa Mohamed Kamel
Publication date
03-01-2024
Publisher
Springer US
Published in
Current Infectious Disease Reports / Issue 1/2024
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-023-00827-3

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