{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:03:49Z","timestamp":1789131829862,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis B virus (HBV) reactivation is a serious complication in patients receiving chronic immunosuppression. Anti\u2010CD20 agents such as Rituximab are considered high risk for HBV reactivation (&gt;\u200910%); therefore, antiviral prophylaxis is recommended for all anti\u2010HBc positive patients. Some studies have suggested that patients with resolved HBV infection and higher hepatitis B surface antibody (anti\u2010HBs) titer have a higher level of protection against reactivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The purpose of this study was to systematically review the role of anti\u2010HBs titer on HBV reactivation in patients on rituximab while not on antiviral therapy\/prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically reviewed all studies that discussed HBV reactivation in patients on rituximab therapy with resolved HBV infection, defined as HBsAg negative and anti\u2010HBc positive, which discussed anti\u2010HBs titer. The search was conducted in PubMed, Embase via Elsevier, Scopus, and Cochrane CENTRAL inclusive July 2025. We evaluated the incidence of HBV reactivation from cohort studies that described anti\u2010HBs categorically based on anti\u2010HBs titer: \u2018negative\u2019 (titer &lt;\u200910 iU\/L), \u201810\u2013100 iU\/L\u2019, or \u2018&gt;\u2009100 iU\/L\u2019. Meta\u2010analysis statistics describe the proportion and risk difference for different anti\u2010HBs levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall reactivation rate was 12.6%. There was a significant difference in HBV reactivation depending on titer: anti\u2010HBs negative 27.3% (51\/195) (20.0%\u201336.0%), titer &lt;\u2009100 iU\/L 13.8% (47\/379) (8.8%\u201320.8%), and titer &gt;\u2009100 iU\/L 3.5% (8\/339) (1.8%\u20136.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Those with anti\u2010HBs titer &gt;\u2009100 iU\/L can be considered lower risk for HBV reactivation and may not require antiviral therapy, but monitoring with initiation of antiviral therapy if titer falls below 100 iU\/L.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70490","type":"journal-article","created":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T10:14:38Z","timestamp":1765707278000},"page":"592-602","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Meta\u2010Analysis: High anti\u2010\n                    <scp>HBs<\/scp>\n                    Titers are Associated with Significantly Reduced Risk of Hepatitis B Virus Reactivation During Rituximab Treatment"],"prefix":"10.1111","volume":"63","author":[{"given":"Shiva","family":"Poola","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Hepatology &amp; Nutrition Brody School of Medicine, East Carolina University\/ECU Health Medical Center  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MaryKate","family":"Kratzer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Hepatology &amp; Nutrition Brody School of Medicine, East Carolina University\/ECU Health Medical Center  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0405-3789","authenticated-orcid":false,"given":"Kerry","family":"Sewell","sequence":"additional","affiliation":[{"name":"Research Librarian for the Health Sciences Brody School of Medicine, East Carolina University  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zikun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Public Health, Brody School of Medicine East Carolina University  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans L.","family":"Tillmann","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Hepatology &amp; Nutrition Brody School of Medicine, East Carolina University\/ECU Health Medical Center  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(16)30579\u20107"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/mcg.0b013e3182972254"},{"key":"e_1_2_10_4_1","unstructured":"Hepatitis B. World Health Organization (2022)."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.02.009"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.07.003"},{"key":"e_1_2_10_7_1","unstructured":"\u201cFDA Drug Safety Communication: Boxed Warning and New Recommendations to Decrease Risk of Hepatitis B Reactivation With the Immune\u2010Suppressing and Anti\u2010Cancer Drugs Arzerra (Ofatumumab) and Rituxan (Rituximab) \u201dFDA (2019)."},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.883"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.02.027"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0016\u20105085(22)63530\u20103"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13421"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.24423"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277\u2010012\u20101405\u20106"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110289"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075\u2010018\u20101748\u2010z"},{"key":"e_1_2_10_17_1","first-page":"102","article-title":"Liver Safety of Non\u2010Tumour Necrosis Factor Inhibitors in Rheumatic Patients With Past Hepatitis B Virus Infection: An Observational, Controlled, Long\u2010Term Study","volume":"36","author":"Papalopoulos I.","year":"2017","journal-title":"Clinical and Experimental Rheumatology"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.151105"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.02.033"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.009"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2021.1948034"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2014.56.7081"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13027\u2010018\u20100215\u20104"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2017.7012"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010018\u201034111\u20105"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/1756\u2010185x.13582"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2025.102551"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.12604"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2024.102447"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(23)03215-4"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.20.01757"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.09.020"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2024.11.008"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2025.03.018"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001549"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0184550"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000001132"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102003\u201005\u20101403"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/v14081780"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10875\u2010012\u20109813\u2010x"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis\u20102021\u2010220781"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010022\u201010665\u20103"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.2147\/IMCRJ.S495506"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.2147\/dddt.s325790"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1649"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.28652"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines10020443"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147\u2010020\u201001814\u20107"}],"container-title":["Alimentary Pharmacology &amp; 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