Shiva Poola, MaryKate Kratzer, Kerry Sewell, Zikun Yang, Hans L. Tillmann
Background Hepatitis B virus (HBV) reactivation is a serious complication in patients receiving chronic immunosuppression. Anti‐CD20 agents such as Rituximab are considered high risk for HBV reactivation (> 10%); therefore, antiviral prophylaxis is recommended for all anti‐HBc positive patients. Some studies have suggested that patients with resolved HBV infection and higher hepatitis B surface antibody (anti‐HBs) titer have a higher level of protection against reactivation. Aim The purpose of this study was to systematically review the role of anti‐HBs titer on HBV reactivation in patients on rituximab while not on antiviral therapy/prophylaxis. Methods We systematically reviewed all studies that discussed HBV reactivation in patients on rituximab therapy with resolved HBV infection, defined as HBsAg negative and anti‐HBc positive, which discussed anti‐HBs titer. The search was conducted in PubMed, Embase via Elsevier, Scopus, and Cochrane CENTRAL inclusive July 2025. We evaluated the incidence of HBV reactivation from cohort studies that described anti‐HBs categorically based on anti‐HBs titer: ‘negative’ (titer < 10 iU/L), ‘10–100 iU/L’, or ‘> 100 iU/L’. Meta‐analysis statistics describe the proportion and risk difference for different anti‐HBs levels. Results The overall reactivation rate was 12.6%. There was a significant difference in HBV reactivation depending on titer: anti‐HBs negative 27.3% (51/195) (20.0%–36.0%), titer < 100 iU/L 13.8% (47/379) (8.8%–20.8%), and titer > 100 iU/L 3.5% (8/339) (1.8%–6.9%). Conclusions Those with anti‐HBs titer > 100 iU/L can be considered lower risk for HBV reactivation and may not require antiviral therapy, but monitoring with initiation of antiviral therapy if titer falls below 100 iU/L.
{"title":"Meta‐Analysis: High anti‐ HBs Titers are Associated with Significantly Reduced Risk of Hepatitis B Virus Reactivation During Rituximab Treatment","authors":"Shiva Poola, MaryKate Kratzer, Kerry Sewell, Zikun Yang, Hans L. Tillmann","doi":"10.1111/apt.70490","DOIUrl":"https://doi.org/10.1111/apt.70490","url":null,"abstract":"Background Hepatitis B virus (HBV) reactivation is a serious complication in patients receiving chronic immunosuppression. Anti‐CD20 agents such as Rituximab are considered high risk for HBV reactivation (> 10%); therefore, antiviral prophylaxis is recommended for all anti‐HBc positive patients. Some studies have suggested that patients with resolved HBV infection and higher hepatitis B surface antibody (anti‐HBs) titer have a higher level of protection against reactivation. Aim The purpose of this study was to systematically review the role of anti‐HBs titer on HBV reactivation in patients on rituximab while not on antiviral therapy/prophylaxis. Methods We systematically reviewed all studies that discussed HBV reactivation in patients on rituximab therapy with resolved HBV infection, defined as HBsAg negative and anti‐HBc positive, which discussed anti‐HBs titer. The search was conducted in PubMed, Embase via Elsevier, Scopus, and Cochrane CENTRAL inclusive July 2025. We evaluated the incidence of HBV reactivation from cohort studies that described anti‐HBs categorically based on anti‐HBs titer: ‘negative’ (titer < 10 iU/L), ‘10–100 iU/L’, or ‘> 100 iU/L’. Meta‐analysis statistics describe the proportion and risk difference for different anti‐HBs levels. Results The overall reactivation rate was 12.6%. There was a significant difference in HBV reactivation depending on titer: anti‐HBs negative 27.3% (51/195) (20.0%–36.0%), titer < 100 iU/L 13.8% (47/379) (8.8%–20.8%), and titer > 100 iU/L 3.5% (8/339) (1.8%–6.9%). Conclusions Those with anti‐HBs titer > 100 iU/L can be considered lower risk for HBV reactivation and may not require antiviral therapy, but monitoring with initiation of antiviral therapy if titer falls below 100 iU/L.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"20 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria de Brito Nunes,Matthias Knecht,Jonas Schropp,Reiner Wiest,Jaume Bosch,Annalisa Berzigotti
BACKGROUND AND STUDY AIMPost-banding ulcer bleeding (PBUB) is an understudied complication of endoscopic band ligation (EBL) used in the prevention and treatment of oesophageal variceal bleeding (VB). The aim of this study is to investigate the incidence, mortality and risk factors of PBUB.METHODSRetrospective cohort study conducted at the university hospital of Bern (Switzerland). It included patients with cirrhosis and oesophageal varices who underwent prophylactic or urgent EBL for VB between 1 January 2018 and 31 December 2022.RESULTSIn total, 206 patients with cirrhosis, who underwent 630 sessions of EBL, were included. The incidence rate of PBUB was 17.5% (95% CI, 12.7%-23.5%), considering the total number of patients, and 6.8% (95% CI, 5.0%-9.2%) considering the total of EBL procedures. Urgent EBL (SHR: 2.78, 95% CI: 1.29-6.00, p = 0.009) and elevated creatinine (SHR: 1.04, 95% CI: 1.01-1.07, p = 0.024) were independent risk factors for PBUB on multivariate analysis. PBUB required blood product transfusions in 88.1% of events (95% CI, 73.6%-95.5%) and hospitalisation at the intensive care unit in 74.4% of events, with a median hospital stay of 2 days (range: 1-34 days). In patients with PBUB, the short-term mortality during hospitalisation was 19%, and long-term mortality at 52 weeks was 64%.CONCLUSIONSPatients with cirrhosis undergoing urgent EBL or those with elevated creatinine levels are at increased risk of PBUB. Due to the high mortality associated with PBUB, identifying high-risk patients and implementing preventive strategies is essential for improving patient outcomes.
{"title":"Post-Banding Ulcer Bleeding After Endoscopic Ligation: Incidence, Risk Factors and Outcomes in Patients With Cirrhosis.","authors":"Maria de Brito Nunes,Matthias Knecht,Jonas Schropp,Reiner Wiest,Jaume Bosch,Annalisa Berzigotti","doi":"10.1111/apt.70495","DOIUrl":"https://doi.org/10.1111/apt.70495","url":null,"abstract":"BACKGROUND AND STUDY AIMPost-banding ulcer bleeding (PBUB) is an understudied complication of endoscopic band ligation (EBL) used in the prevention and treatment of oesophageal variceal bleeding (VB). The aim of this study is to investigate the incidence, mortality and risk factors of PBUB.METHODSRetrospective cohort study conducted at the university hospital of Bern (Switzerland). It included patients with cirrhosis and oesophageal varices who underwent prophylactic or urgent EBL for VB between 1 January 2018 and 31 December 2022.RESULTSIn total, 206 patients with cirrhosis, who underwent 630 sessions of EBL, were included. The incidence rate of PBUB was 17.5% (95% CI, 12.7%-23.5%), considering the total number of patients, and 6.8% (95% CI, 5.0%-9.2%) considering the total of EBL procedures. Urgent EBL (SHR: 2.78, 95% CI: 1.29-6.00, p = 0.009) and elevated creatinine (SHR: 1.04, 95% CI: 1.01-1.07, p = 0.024) were independent risk factors for PBUB on multivariate analysis. PBUB required blood product transfusions in 88.1% of events (95% CI, 73.6%-95.5%) and hospitalisation at the intensive care unit in 74.4% of events, with a median hospital stay of 2 days (range: 1-34 days). In patients with PBUB, the short-term mortality during hospitalisation was 19%, and long-term mortality at 52 weeks was 64%.CONCLUSIONSPatients with cirrhosis undergoing urgent EBL or those with elevated creatinine levels are at increased risk of PBUB. Due to the high mortality associated with PBUB, identifying high-risk patients and implementing preventive strategies is essential for improving patient outcomes.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"44 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mattias Mandorfer, Mathias Jachs, Tânia Carvalho, Thomas Reiberger
<p>We would like to thank Drs. Zhu and Li for their editorial [<span>1</span>], which discusses key findings of our study [<span>2</span>] and addresses important points.</p>