Rituximab and other anti-CD20 drugs can reactivate hepatitis B, including in people who are surface antigen negative but core antibody positive, and reactivation can cause fulminant hepatitis.
Before the first dose, test hepatitis B surface antigen and core antibody. Patients positive for either need specialist advice on antiviral prophylaxis. This applies whoever is prescribing — rheumatology, nephrology, neurology or haematology — and matters more in India, where past hepatitis B exposure is common.
- Test hepatitis B surface antigen and core antibody before starting rituximab or another anti-CD20 drug
- Core antibody positive alone still carries reactivation risk
- Seek specialist advice on antiviral prophylaxis for anyone positive
- Check vaccination status and plan vaccines before B-cell depletion where possible
Why it matters
Anti-CD20 drugs now cross many specialties, and so does the reactivation risk.
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