Questionnaire Survey on Preventions of Hepatitis B Virus Reactivation Induced by Immunosuppressive Therapy and Chemotherapy in National University Hospitals in Japan

Abstract

Objective: Pre-therapeutic screening is recommended for the prevention of hepatitis B virus (HBV) reactivation in patients requiring chemotherapy and immunosuppressive therapy. There are several safety measures to increase the screening rate, which differ among hospitals. The aim of this study is to clarify the safety measures and their problems in national university hospital in Japan.
Methods: In November 2020, we conducted a questionnaire to 42 national university hospitals in Japan. We investigated the concrete operating procedures and challenges of safety measures to promote HBV screening.
Results: The questionnaires were answered by 41 hospitals, and 35 hospitals (85%) had implemented a range of safety measures to prevent HBV reactivation. As safety measures to promote antigen-antibody testing, "education of physicians” and “prescription appraisal by pharmacists" were implemented in 24 hospitals (69%), and "the alert system on electronic medical records" had been established in 17 hospitals (49%), of which 4 hospitals had included steroids in the drugs subject to alerts. The period of validity for antigen-antibody test was set in 8 hospitals, and the period varied from 6 months to 5 years. It was revealed that the challenges in establishing the alert system included technical difficulties, as well as the difficulty of uniform control in the system due to the variety of diseases, doses and durations covered by the target drugs in the guidelines, and the concern of alert fatigue.
Conclusions: As measures to prevent hepatitis B reactivation, this study found that the education of physicians and the prescription audits by pharmacists are widely practiced, and that when constructing electronic alert system for HBV screening, it should be designed with careful consideration of alert criteria and indications.