Prevention of hepatitis B reactivation in patients requiring chemotherapy and immunosuppressive therapy

Table 1 Immunosuppressive agent classes and corresponding risks of hepatitis B reactivation

Risk group	Seropositive for HBsAg and anti-HBc	Seronegative for HBsAg, seropositive for anti-HBc
High risk (> 10%)	Anti-CD20 antibodies	Anti-CD20 antibodies
	Anti-CD52 antibodies
	Anthracycline derivatives
	Costimulation inhibitors
	JAK inhibitors
	Moderate-high dose corticosteroid therapy1 for ≥ 4 wk
Moderate risk (1%-10%)	TNF-α inhibitors	Anthracycline derivatives
	Integrin inhibitors	TNF-α inhibitors
	IL-12 and IL-23 antibodies	Integrin inhibitors
	Tyrosine kinase inhibitors	IL-12 and IL-23 antibodies
	Low dose corticosteroid therapy1 for ≥ 4 wk	Tyrosine kinase inhibitors
		Moderate-high dose corticosteroid therapy1 for ≥ 4 wk
Low risk (< 1%)	General immunosuppressive agents (azathioprine, 6-mercaptopurine and methotrexate)	General immunosuppressive agents (azathioprine, 6-mercaptopurine and methotrexate)
	Corticosteroid therapy1 for ≤ 1 wk	Low dose corticosteroid therapy1 for ≥ 4 wk
	Intra-articular corticosteroids	Corticosteroid therapy1 for ≤ 1 wk
		Intra-articular corticosteroids

¹Corticosteroid therapy: Prednisone (or equivalent); low dose (< 10 mg), moderate dose (10-20 mg), high dose (> 20 mg). anti-HBc: Hepatitis B core antibodies; HBsAg: Hepatitis B surface antigen; IL: Interleukin; JAK: Janus kinase; TNF: Tumor necrosis factor.