From the Guidelines
Herpes simplex virus (HSV) prophylaxis is not universally recommended for patients taking Zanubrutinib, but it should be considered in selected subjects with a history of recurrent HSV reactivations or additional risk factors. According to the most recent guidelines, as stated in the study published in Blood Reviews in 2024 1, the decision to use antiviral prophylaxis against HSV should be individualized based on the patient's risk factors. Some key points to consider when deciding on HSV prophylaxis for patients on Zanubrutinib include:
- The incidence of serious viral infections in patients with chronic lymphocytic leukemia (CLL) treated with targeted agents is relatively low, with HSV/VZV infections accounting for a minority of episodes 1.
- Patients with a history of recurrent HSV reactivations or those receiving concomitant treatment with high-dose steroids or rituximab may benefit from antiviral prophylaxis 1.
- The adjuvanted recombinant zoster vaccine (RZV) is recommended as a preventive strategy to reduce the incidence and severity of VZV reactivations and potentially reduce the need for prophylaxis 1. It is essential to weigh the benefits and risks of antiviral prophylaxis for each patient, taking into account their individual risk factors and medical history, as stated in the study 1.
From the Research
Herpes Simplex Virus Prophylaxis with Zanubrutinib
- There is no direct evidence in the provided studies that specifically addresses the need for herpes simplex virus (HSV) prophylaxis with Zanubrutinib, a Bruton's tyrosine kinase inhibitor.
- However, it is known that immunocompromised patients, such as those with B-cell malignancies treated with BTK inhibitors, may be at increased risk of viral infections, including HSV 2.
- The studies provided focus on the efficacy and safety of Zanubrutinib in patients with B-cell malignancies, including its approval for treating adults with mantle cell lymphoma, Waldenström macroglobulinemia, and marginal zone lymphoma 3, 4, 5.
- While Zanubrutinib has shown promising efficacy and a manageable safety profile, the risk of viral infections, including HSV, should be considered in the context of immunosuppression 3, 4, 5.
- A study on the management of HSV infections highlights the need for antiviral prophylaxis in immunocompromised patients to prevent the development of drug-resistant viral isolates 2.
- In the absence of direct evidence, it is reasonable to consider the general principles of managing viral infections in immunocompromised patients when using Zanubrutinib, which may include antiviral prophylaxis for HSV, especially in patients with a history of HSV infection or those at high risk of reactivation 2.