Hepatitis B Screening Before Biologic or Targeted Synthetic Disease-modifying Antirheumatic Drug Therapy: Many Roads to Improvement
Bibliographic record
Abstract
Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) have long been recognized to cause hepatitis B virus (HBV) reactivation in individuals chronically infected with or previously exposed to HBV.1 Despite this knowledge, many patients treated with b/tsDMARDs experience HBV reactivation each year because of inconsistent screening.2 Because of its largely asymptomatic clinical expression and low testing rates, the HBV burden in patients with rheumatic diseases is difficult to determine. However, HBV is likely more common than we may suspect, based on studies conducted in the general population. In the US, an estimated 875,000 persons are living with chronic HBV (HBsAg-positive), although prior or resolved HBV (HBcAb-positive, HBsAg-negative, with or without HBsAb) is much more common, affecting up to 11 million persons.3,4 Most of these individuals are either undiagnosed or unaware of their HBV status, as is the case with up to 75% of persons with chronic HBV.5 Because HBV infection is common and underdiagnosed, and immunosuppression with b/tsDMARDs can lead to HBV reactivation with deleterious consequences ranging from HBV DNA elevations to fatal liver failure,1 HBV screening prior to b/tsDMARD initiation is a relatively simple, low-cost step critical to delivering high-quality rheumatologic care. The article by Mohareb et al in this issue of The Journal of Rheumatology is a timely addition to research on drug safety of newer b/tsDMARDs in patients with rheumatic diseases, exploring deficiencies in HBV screening practices in individuals initiating tocilizumab (TCZ) or tofacitinib (TOF) in an integrated health network.6 Both agents are increasingly recognized to carry a risk of HBV reactivation7,8 and despite their growing use in rheumatology, little is known about practices to ensure their safe administration. This study found that HBV screening in new users of TCZ or TOF was remarkably low, with … Address correspondence to Dr. A. Aguirre, Division of Rheumatology, University of California, San Francisco, 4150 Clement St. (111R), San Francisco, CA 94121, USA. Email: alfredo.aguirre{at}ucsf.edu.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.052 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.006 | 0.010 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.009 | 0.016 |
| Insufficient payload (model declined to judge) | 0.017 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".