Table 3.

Risk of hepatitis B virus reactivation stratified by immunosuppressive regimen

HBsAg positiveHBsAg negative – anti-HBc positive
High risk >10%
  • B-cell depleting agents (eg rituximab, ofatumumab)

  • Anthracycline derivatives (eg doxorubicin, epirubicin)

  • Moderate (prednisolone 10–20 mg daily or equivalent) or high-dose (prednisolone >20 mg daily or equivalent) corticosteroids daily for ≥4 weeks

  • Potent TNF-α inhibitors, including adalimumab, certolizumab, infliximab and golimumab

  • Local treatment for HCC, including TACE

  • B-cell depleting agents (eg rituximab, ofatumumab)

Moderate risk 1-10%
  • Less potent TNF-α inhibitors (eg etanercept)

  • Cytokine or integrin inhibitors (eg abatacept, ustekinumab, natalizumab, vedolizumab)

  • Tyrosine kinase inhibitors (eg imatinib, nilotinib)

  • Immunophilin inhibitors, including cyclosporine

  • Proteasome inhibitors, such as bortezomib

  • HDIs

  • Low-dose (prednisolone <10 mg daily or equivalent) corticosteroids for duration of ≥4 weeks

  • Systemic chemotherapy

  • TNF-α inhibitors (eg etanercept, adalimumab, certolizumab, infliximab)

  • Cytokinee or integrin inhibitors (eg abatacept, ustekinumab, natalizumab, vedolizumab)

  • Tyrosine kinase inhibitors (eg imatinib, nilotinib)

  • Moderate (prednisolone 10–20 mg daily or equivalent) or high-dose (prednisolone >20 mg daily or equivalent) corticosteroids daily for ≥4 weeks

  • Anthracycline derivatives (eg doxorubicin, epirubicin)

  • Immunophilin inhibitors, including cyclosporine

  • Proteasome inhibitors, such as bortezomib

  • HDIs

  • Systematic chemotherapy, including HCC

Low risk <1%
  • Traditional immunosuppressive agents (eg azathioprine, 6-Mercaptopurine, methotrexate)

  • Intra-articular corticosteroids

  • Any dose of oral corticosteroids daily for <1 week

  • Traditional immunosuppressive agents (eg azathioprine, 6-Mercaptopurine, methotrexate)

  • Intra-articular corticosteroids

  • Low-dose (prednisolone <10 mg or equivalent) corticosteroids for ≥4 weeks

  • Any dose of oral corticosteroids daily for <1 week

  • Anti-HBc = hepatitis B core antibody; HBsAg = hepatitis B surface antigen; HBVr = hepatitis B virus reactivation; HCC = hepatocellular carcinoma; HDIs = histone deacetylase inhibitors; TACE = transarterial chemoembolization; TNF = tumour necrosis factor