Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study
Antonio Riccardo Buonomo, Giulio Viceconte, Massimiliano Calabrese, Giovanna De Luca, Valentina Tomassini, Paola Cavalla, Giorgia Teresa Maniscalco, Diana Ferraro, Viviana Nociti, Marta Radaelli, Maria Chiara Buscarinu, Damiano Paolicelli, Alberto Gajofatto, Pietro Annovazzi, Federica Pinardi, Massimiliano Di Filippo, Cinzia Cordioli, Emanuela Zappulo, Riccardo Scotto, Ivan Gentile, Antonio Luca Spiezia, Martina Petruzzo, Marcello De Angelis, Vincenzo Brescia Morra, Claudio Solaro, Claudio Gasperini, Eleonora Cocco, Marcello Moccia, Roberta Lanzillo, Raising Italian Researchers in Multiple Sclerosis (RIREMS) study group
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.