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. 2022 Jun;269(6):3301-3307.
doi: 10.1007/s00415-022-11009-x. Epub 2022 Feb 14.

Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study

Antonio Riccardo Buonomo  1 , Giulio Viceconte  2 , Massimiliano Calabrese  3 , Giovanna De Luca  4 , Valentina Tomassini  4 , Paola Cavalla  5 , Giorgia Teresa Maniscalco  6 , Diana Ferraro  7 , Viviana Nociti  8 , Marta Radaelli  9 , Maria Chiara Buscarinu  10 , Damiano Paolicelli  11 , Alberto Gajofatto  3 , Pietro Annovazzi  12 , Federica Pinardi  13 , Massimiliano Di Filippo  14 , Cinzia Cordioli  15 , Emanuela Zappulo  1 , Riccardo Scotto  1 , Ivan Gentile  1 , Antonio Luca Spiezia  16 , Martina Petruzzo  16 , Marcello De Angelis  16 , Vincenzo Brescia Morra  16 , Claudio Solaro  17 , Claudio Gasperini  18 , Eleonora Cocco  19 , Marcello Moccia #  16 , Roberta Lanzillo #  16 ; Raising Italian Researchers in Multiple Sclerosis (RIREMS) study group
Affiliations

Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study

Antonio Riccardo Buonomo et al. J Neurol. 2022 Jun.

Erratum in

Abstract

Background: Patients with multiple sclerosis (MS) often receive disease-modifying therapies (DMTs) that can expose them to reactivation of potential occult hepatitis B virus (HBV) infection (pOBI). We aimed to evaluate the MS Centers behavior regarding HBV screening and prophylaxis in a large cohort of MS patients receiving anti-CD20 or cladribine.

Methods: Retrospective, multicentric study recruiting Italian MS patients treated with rituximab, ocrelizumab and cladribine.

Results: We included 931 MS patients from 15 centers. All but 38 patients performed a complete HBV screening. Patients' age > 50 years was significantly associated with no history of vaccination and HBsAb titres < 100 mIU at baseline (p < 0.001). No significant correlation was found between post-vaccination HBsAb titres and type of treatment (p = 0.5), pre-or post-therapy vaccination (p = 0.2) and number of previous DMTs (p = 0.2). Among pOBI patients (n = 53), 21 received antiviral prophylaxis, while only 13 had HBV DNA monitoring and 19 patients neither monitored HBV DNA nor received prophylaxis.

Conclusions: Baseline HBV screening in patients receiving anti-CD20 and cladribine is a consolidated practice. Nonetheless, HBV vaccination coverage is still lacking in such population and age is a significant factor associated with low HBV protection. Rituximab, ocrelizumab and cladribine did not impair HBV vaccine response. Almost 35% of pOBI patients fail to receive HBVr prevention. Management of HBV prophylaxis could be improved in MS patients and further prospective studies are needed to assess the effectiveness of prophylactic strategies in such patients.

Keywords: Cladribine; Hepatitis B; Multiple sclerosis; Ocrelizumab; Rituximab; Vaccination.

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Conflict of interest statement

The authors have no competing interests to disclose.

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