童綜合醫院50周年院慶暨跨領域學術論壇:免疫抑制劑與B肝防治-回顧與最新進展

項目內容
時間2021-06-05的09:00至12:10
類型丙類
積分0.5
主辦單位童綜合醫療社團法人童綜合醫院
會議地點臺中市梧棲區臺灣大道八段699號20樓視聽教室
*化療藥物與B型肝炎復發:HBV reactivation is a critical issue in patients undergoing chemotherapy. Among different chemotherapeutic regimens, rituximab or steroid-containing regimens are most vulnerable to HBV reactivation. In the past, HBV prophylaxis among patients with HBsAg (+) is the standard of care. Recently, the unmet need in patients with anti-HBc antibody (+) has been raised. These patients are defined to have occult HBV infections. Recent data have shown that HBV prophylaxis among cancer patients with occult HBV infection is highly recommended when these patients are undergoing chemotherapy. The HBV prophylaxis should not discontinue until 6-12 months after the chemotherapy. *非化療藥物與B肝復發:Although the incidence of new hepatitis B patient is decreasing over the past decades on hemodialysis patient. We face an emerging challenge of reactivation in prior hepatitis B-infection hemodialysis patient as the antibody decreases as time flows. Although we do a regular checkup of hepatitis B antigen and antibody annually in such patients, we still have a big issue about re-activation or new transmission by viral hepatitis B when serum level of viral hepatitis B surface antigen turned from negative to positive. We have to do more detailly and what can we do? *B肝復發之風險管理-台灣世代研究成果:In a prospective study from January 2013 to June 2017, we monitored the HBV serostatus of HBsAg−/HBcAb+ patients undergoing biologic therapy for rheumatic diseases. From HBsAb titers at baseline and subsequent time points, we calculated the person-years (PY) contributed by patients with different HBsAb levels: < 10 mIU/mL (negative); 10–100 mIU/mL (low); and > 100 mIU/mL (high). We analyzed the incidence of detectable HBV DNA and HBV reactivation in each group, and documented the clinical courses of patients. Among 380 participants, 83 (21.8%) had baseline HBsAb < 10 mIU/mL, 156 (41.1%) HBsAb 10–100 mIU/mL, and 141 (37.1%) HBsAb > 100 mIU/mL. Total PY at study end were 169.3 PY from the HBsAb-negative group, 362.7 PY from the low-titer group, and 285.8 PY from the high-titer group. Seventeen patients had detectable HBV DNA, with respective incidence rates in negative, low- and high-titer groups of 4.7/100 PY, 2.5/100 PY, and 0/100 PY. Two HBsAb-negative patients subsequently developed HBV reactivation, an incidence of 1.2/100 PY. The risk of HBV reactivation varied with HBsAb titer, which changed during biologic therapy. Neither HBV DNA nor reactivation were detected in patients with HBsAb > 100 mIU/mL, whereas HBV DNA without reactivation occurred periodically in patients with HBsAb 10–100 mIU/mL; HBsAb-negative serostatus was associated with a risk of HBV reactivation. *B肝用藥與最新指引:Hepatitis B reactivation induced by immunosuppressive therapy or cytotoxic chemotherapy is common among hepatitis B virus (HBV) carriers, and the prevalence has been reported to be as high as 20-50%. Hepatitis B reactivation not only necessitates delay in the chemotherapy schedule or premature termination of treatment, but also results in hepatic failure and death in 5% to 40% of HBV carriers. Prophylactic antivirals can reduce the chance of HBV reactivation and patient mortality, and international guidelines have recommended antiviral prophylaxis before the start of chemotherapy. However, many HBV carriers don’t receive prophylactic antivirals before chemotherapy due to the high cost of drugs, lack of insurance coverage, lack of awareness of the patient’s condition or neglect by physicians. Even in developed countries, the screening rate of HBV infection for newly-diagnosed cancer patients who will receive chemotherapy may be less than 20%. Chemotherapy-induced hepatitis B flare-up is involved in rapidly increased viral replication in the immunosuppression phase, and extensive destruction of infected hepatocytes during restoration of immunity after chemotherapy. Although urgent antiviral therapy has until now been the only reliable way to rescue hepatitis flare-up, some patients will still die from hepatic failure. For avoiding the possibility of hepatic failure or immunosuppressive therapy/ cytotoxic chemotherapy interruption/ discontinuation, current evidence recommends the prophylaxis antiviral therapy for HBV carriers. In this speech, the updated international practice guidelines and the latest reimbursement criteria of the Taiwan’s National Health Insurance will be reviewed.
Time topic Speaker Moderator
9:00-9:10 Opening 童綜合醫院
童敏哲總院長
9:10-9:50 化療藥物與B肝復發 台中榮總
血液腫瘤科
滕傑林
童綜合醫院
血液腫瘤科
沈俊佑
9:50-10:30 非化療藥物與B肝復發 童綜合醫院
腎臟科
吳再坤
童綜合醫院
腎臟科
林柏松
10:30-10:40 Break
10:40-11:20 B肝復發之風險管理-
台灣世代研究成果
童綜合醫院
風濕免疫科
邱瑩明
中國附醫
風濕免疫科
藍忠亮
11:20-12:00 B肝用藥與最新指引 台中榮總
腸胃肝膽科
李騰裕
童綜合醫院
腸胃肝膽科
葉宏仁
12:00-12:10 Closing 童綜合醫院
李博仁副院長