AJMC Staff

A recent retrospective analysis assessed the incidence of hepatitis B virus (HBV) reactivation among patients with myeloproliferative neoplasms (MPN) during and after treatment with 

The issue of reactivation of HBV and other chronic viruses such as herpes zoster is an emerging issue in hematologic malignancies, due to the potency of the improved therapies. In general, the risk of HBV reactivation is different in patients with chronic HBV and resolved HBV.

Anti-CD20 monoclonal antibodies and ibrutinib have been linked with an increased risk of HBV reactivation in patients with previous infections, 

. Ruxolitinib, a Janus kinase (JAK) inhibitor, weakens dendritic cell and T-cell functions, lowering cytokine production, which results in impaired control of silent infections and an increased risk of virus reactivation.

In prior trials, a few patients were reported to experience HBV reactivation after ruxolitinib, but the actual incidence of HBV reactivation in patients with MPN and chronic or resolved HBV infection during and after ruxolitinib treatment remains unclear.

This study was conducted in China; 224 patients with MPN were treated using ruxolitinib between February 2013 and February 2020.

Of the 224, 162 were excluded for being negative to all tests for HBV or for being positive for HBsAb only.

Of the 62 patients with resolved or chronic HBV treated with ruxolitinib, 58.1% were male, with a median age of 53.5. A little more than half had primary myelofibrosis; the remaining had various types of essential thrombocythemia or polycythemia vera.

Of 62 patients, 6 had chronic HBV, and 56 had resolved HBV infection. Of the 56 who had resolved infection, 43 patients had received combination treatment with thalidomide, prednisone, and stanozolol (TSP) during ruxolitinib treatment.

Of the 6 with chronic HBV, 2 did not take any antiviral prophylaxis and subsequently developed HBV reactivation and a flare of hepatitis.

The other 4 patients with chronic HBV infection did receive antiviral prophylaxis therapy before treatment with ruxolitinib did not develop HBV reactivation.

Of patients with resolved HBV infection who received antiviral prophylaxis, none of them experienced a reactivation of their infection.

The authors said the study had 3 limitations: retrospective observations were limited by patient variability in monitoring HBV; the study had a small sample size; and the study had relatively short media follow-up (23.21 months).

The authors said the study showed that HBV reactivation and hepatitis flare might occur a few months after ruxolitinib treatment in patients with chronic HBV infection who did not take antivirals prophylactically, especially in combination with TSP. 

However, it was rare in patients with resolved HBV infection.

Duan MH, Cao XX, Chang L, Zhou DB. Risk of hepatitis B virus reactivation following ruxolitinib treatment in patients with myeloproliferative neoplasms. 

. 2021 Dec;26(1):460-464. doi: 10.1080/16078454.2021.1945234.

Articles

The issue of reactivating hepatitis B and other chronic viruses such as herpes zoster after treatment for myeloproliferative neoplasms (MPN) is an emerging issue in hematologic malignancies, due to the power of newer therapies.

Reactivation of Hepatitis B After Ruxolitinib for MPN Hinges on Antivirals

A study published in the July 2021 issue of 

Large Self-insured Employers Lack Power to Effectively Negotiate Hospital Prices

. In the study, authors examined the ability of self-insured employers to negotiate hospital prices, with findings showing low market power of employers in most metropolitan areas.

 referenced a study published online ahead of print for the December 2021 issue of 

Availability of Prices for Shoppable Services on Hospital Internet Sites

,” indicated that many hospitals are in violation of new federal legislation with only 60% of hospitals displaying their cash prices and 5% displaying their minimum negotiated charges on their public websites. The study was also mentioned by the 

Coverage of our peer-reviewed research and news reporting in the health care and mainstream press.

AJMC® in the Press, July 23, 2021

Mississippi’s attorney general is urging the Supreme Court to overturn Roe v. Wade, the ruling that secured a woman’s right to an abortion, 

. Calling the decision “egregiously wrong,” Attorney General Lynn Fitch hopes to sustain a state law that bans most abortions after 15 weeks of pregnancy. The conservative-majority Supreme Court is scheduled to hear arguments on the case in the fall, while lower courts have previously blocked the Mississippi statute. Fitch has argued the scope of abortion rights should be determined through the political process.

More Funds Released to Combat Delta Variant

Following increasing rates of COVID-19 infections, hospitalizations, and deaths seen across the United States, the White House announced new funds for COVID-19 testing and vaccination will be released, according to 

 In particular, about $100 million in new funds will be directed at rural health clinics to aid in vaccine outreach, as these are often located in areas with low vaccination rates and may be more trusted among community members. An additional $1.6 billion will go toward testing in prisons and homeless and domestic violence shelters. The money will come out of the American Rescue Plan relief package.

The Missouri Supreme Court ruled an additional 270,000 low-income individuals will now be eligible for publicly funded health care, NPR 

 Although voters in the state had previously approved a constitutional amendment to adopt Medicaid expansion, the Republican-led legislature declined to implement it. Following this refusal, Governor Mike Parson (R) stopped the plans to bolster the state's health care system. But in an unanimous opinion, the state’s Supreme Court ruled new Medicaid recipients would join the existing pool of beneficiaries in the state.

Mississippi's attorney general asks the Supreme Court to overturn Roe v Wade; the Biden administration releases more COVID-19 funds to combat the delta variant; Missouri Supreme Court rules to expand health care access. 

What We’re Reading: Roe v Wade Challenge; New COVID-19 Funds Amid Delta Surge; Missouri Broadens Health Coverage

Federal Government Requires Coverage for PrEP

The federal government will require all health insurers to cover both versions of PrEP, Truvada and Descovy, essentially allowing patients to maintain their prescription for the HIV prevention medication without cost sharing. However, 

 reported that prescribing physicians will be asked to persuade insurers that Descovy is medically necessary for patients for the drug to qualify for $0 cost sharing. Insurers will have 60 days to comply with the mandate and they will not be allowed to charge copays, coinsurance, or deductible payments for the mandated clinic visits and lab tests for maintaining a PrEP prescription. The mandate comes after insurers were required to cease out-of-pocket fees for PrEP on January 1, 2021.

Johnson & Johnson (J&J) along with pharmaceutical wholesalers McKesson, AmerisourceBergen, and Cardinal Health, reached a settlement agreement of $26 billion in a lawsuit accusing the companies of instigating the opioid crisis, according to 

. About 3000 lawsuits were filed by states, counties, cities, and tribes claiming that the wholesalers did not appropriately monitor suspicious shipments and that drug makers were accused of downplaying addiction risks for opioid painkillers and encouraged overprescribing of the medications. The wholesalers will pay up to $21 billion over the next 18 years and J&J will pay $9 billion over 9 years and will cease opioid sales. Over 40 states are anticipated to agree to the settlement and have 30 days to sign on to the deal. Local governments have an additional 120 days to sign the deal.

NYC Requires COVID-19 Vaccinations for Health Care Workers

Mayor Bill de Blasio said health care workers in New York City hospitals and health clinics will be required to either get vaccinated or take weekly COVID-19 tests. According to 

, de Blasio said that he hopes the move will encourage hesitant health care workers to get vaccinated as the city places a larger emphasis on reaching out to vaccine holdouts and the delta variant causes US cases to 

 in the last week. The requirement will go into effect on August 2. Workers who refuse both options will be subjected to suspension without pay. The rule will apply to all doctors, nurses, administrative staff, and custodians that work in the city’s public Health + Hospitals health care system, which only has 60% of its staff vaccinated, and the city’s health department.

The federal government requires insurers to cover PrEP; Johnson & Johnson (J&J) and pharmaceutical wholesalers agree to settle opioid crisis lawsuits; NYC health care workers will be required to receive a vaccine or weekly tests for COVID-19.

AJMC Staff

Articles

Reactivation of Hepatitis B After Ruxolitinib for MPN Hinges on Antivirals

AJMC® in the Press, July 23, 2021

What We’re Reading: Roe v Wade Challenge; New COVID-19 Funds Amid Delta Surge; Missouri Broadens Health Coverage

What We’re Reading: US Tells Insurers to Cover PrEP; Opioid Lawsuit Settlement; NYC Requires COVID-19 Vaccinations