Compliance of protocol-driven hepatitis B serological screening in patients receiving anti-CD20 monoclonal antibody therapy.

Abstract

261 Background: The US Food and Drug Administration has issued a boxed warning for anti-CD20 monoclonal anti-bodies for the reactivation of Hepatitis B virus (HBV) infection. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma and Infectious Diseases Society of America guidelines recommend routine serologic testing for all patients receiving anti-CD20 antibody therapy. NCCN specifies serologic screening of HBV surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) should be completed prior to initiation of anti-CD20 therapy. In March 2018, UCHealth included HBV screening into the EHR oncology templates which include an anti-CD20 monoclonal antibody. The purpose of this study was to assess the impact of this template modification on compliance to guideline recommended screening for patients receiving anti-CD20 monoclonal antibody therapy. Methods: This was a retrospective chart review of patients who received an anti-CD20 monoclonal antibody for an oncologic indication between April 1, 2017 to November 30, 2017 (pre-template change) and April 1, 2018 to November 30, 2018 (post-template change) at any of the UCHealth Cancer Care and Hematology Centers. The primary objective was the composite compliance rate of HBsAg and HBcAb screening completed prior to receipt of treatment. Secondary objectives included compliance rate of each screening test, days between screening and treatment, screening for initial compared to relapse therapy, and rate of hepatitis C virus screening. Results: The addition HBV serologic screening to the EHR oncology templates containing an anti-CD20 agent improved screening compliance of HBsAg and HBcAb by 6.7% as a system (2017: 89.7% vs 2018: 96.4% [p = 0.133]). Secondary endpoints saw an increase in testing of each individual screening, testing for patients in the relapse setting, and HCV screening. Additionally, a reduction was seen in median days between screening and start of therapy (2017: 11 (4.5-30.3 IQR) vs 2018: 7 (2-14 IQR) [p = 0.008]). Conclusions: The addition of HBV serologic screening to EHR oncology templates increased compliance to guideline recommended screening for patients receiving anti-CD20 antibody therapy.