Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

Table 2 Immunosuppressive drug classes and corresponding risk estimates of hepatitis B virus reactivation[63,80]

Drug class	Drug	Risk estimate of HBVrfor HBsAg positive	Risk estimate of HBVr forHBsAg negative/anti-HBc positive
B-cell depleting agents	Rituximab (anti-CD20)	High (30%-60%)	High (> 10%)
	Ofatumumab (anti-CD20)
Anthracycline derivatives	Doxorubicin	High (15%-30%)	High (> 10%)
	Epirubicin
TNF-α inhibitors	Infliximab	Moderate (1%-10%)	Moderate (1%)
	Etanercept
	Adalimumab
Cytokine inhibitors	Abatacept (anti-CD80, -86)	Moderate (1%-10%)	Moderate (1%)
and integrin inhibitors	Ustekinumab (anti-IL-12, -23)
	Natalizumab (binds α4-integrin)
	Vedolizumab [binds integrin α4β7 (LPAM-1)]
Tyrosine kinase inhibitors	Imantinib	Moderate (1%-10%)	Moderate (1%)
	Nilotinib
Corticosteroids	High dose, e.g., prednisone ≥ 20 mg for ≥ 4 wk	High (> 10%)	NA
	Moderate dose, e.g., prednisone < 20 mg for ≥ 4 wk	Moderate (1%-10%)	Moderate (1%-10%)
	Low dose, e.g., prednisone for < 1 wk	Low (< 1%)	Low (<< 1%)
	Intra-articular corticosteroids	Low (< 1%)	Low (<< 1%)
Traditional immunosuppression	Azathioprine	Low (< 1%)	Low (<< 1%)
	6-mercaptopurine
	Methotrexate

TNF: Tumour necrosis factor; IL: Interleukin; LPAM: Lymphocyte Peyer’s patch adhesion molecule; NA: Not available; HBVr: Hepatitis B reactivation; HBsAg: Hepatitis B surface antigen.