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Management of hepatitis B virus (HBV) infection in multiple sclerosis patients on disease modifying therapies (DMTs)

Buonomo, Antonio Riccardo ; Viceconte, Giulio ; Nicolini, Laura Ambra ; Habibović, Selma ; Rajan, Asha K. ; Santos, Lurdes ; Gherlan, George Sebastian ; Miron, Victor Daniel ; Şahin, Gülşen Özkaya LU and Săndulescu, Oana (2025) In Future Virology 20(5). p.187-196
Abstract

Disease-modifying therapies (DMTs) for multiple sclerosis (MS) can increase the risk of hepatitis B virus (HBV) reactivation (HBr), particularly with agents like ocrelizumab and alemtuzumab. However, studies in MS patients treated with DMTs indicate significantly lower reactivation rates compared to those with hematologic malignancies. This review discusses strategies for managing HBV in MS patients, including chronic hepatitis and potential occult HBV infection (pOBI), with a focus on optimizing safety during DMT therapy. All patients with HBV-related hepatitis should be treated with high genetic barrier nucleoside analogues. In chronic HBV infection, anti-HBV prophylaxis is recommended before initiating DMTs associated with high or... (More)

Disease-modifying therapies (DMTs) for multiple sclerosis (MS) can increase the risk of hepatitis B virus (HBV) reactivation (HBr), particularly with agents like ocrelizumab and alemtuzumab. However, studies in MS patients treated with DMTs indicate significantly lower reactivation rates compared to those with hematologic malignancies. This review discusses strategies for managing HBV in MS patients, including chronic hepatitis and potential occult HBV infection (pOBI), with a focus on optimizing safety during DMT therapy. All patients with HBV-related hepatitis should be treated with high genetic barrier nucleoside analogues. In chronic HBV infection, anti-HBV prophylaxis is recommended before initiating DMTs associated with high or intermediate HBr risk, ideally with high genetic barrier NAs. For patients with pOBI receiving B-cell–targeting DMTs, those who are HBsAb-negative or have HBsAb titers < 100 mIU/mL may benefit more from antiviral prophylaxis with lamivudine rather than a preemptive approach. Conversely, pOBI patients with HBsAb titers > 100 mIU/mL may follow a preemptive strategy, involving HBV DNA monitoring and starting prophylaxis only if antibody levels drop below the protective threshold. HBV vaccination is highly recommended for all nonimmune MS patients, with vaccine efficacy in MS patients appearing comparable to that of the general population.

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type
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publication status
published
subject
keywords
alemtuzumab, disease-modifying therapies, Hepatitis B virus, multiple sclerosis, ocrelizumab, potential occult HBV infection
in
Future Virology
volume
20
issue
5
pages
10 pages
publisher
Taylor & Francis
external identifiers
  • scopus:105002476279
ISSN
1746-0794
DOI
10.1080/17460794.2025.2484834
language
English
LU publication?
yes
id
070be02b-76ce-4932-9548-5a28d092f5cb
date added to LUP
2025-09-01 11:49:57
date last changed
2025-09-01 12:07:09
@article{070be02b-76ce-4932-9548-5a28d092f5cb,
  abstract     = {{<p>Disease-modifying therapies (DMTs) for multiple sclerosis (MS) can increase the risk of hepatitis B virus (HBV) reactivation (HBr), particularly with agents like ocrelizumab and alemtuzumab. However, studies in MS patients treated with DMTs indicate significantly lower reactivation rates compared to those with hematologic malignancies. This review discusses strategies for managing HBV in MS patients, including chronic hepatitis and potential occult HBV infection (pOBI), with a focus on optimizing safety during DMT therapy. All patients with HBV-related hepatitis should be treated with high genetic barrier nucleoside analogues. In chronic HBV infection, anti-HBV prophylaxis is recommended before initiating DMTs associated with high or intermediate HBr risk, ideally with high genetic barrier NAs. For patients with pOBI receiving B-cell–targeting DMTs, those who are HBsAb-negative or have HBsAb titers &lt; 100 mIU/mL may benefit more from antiviral prophylaxis with lamivudine rather than a preemptive approach. Conversely, pOBI patients with HBsAb titers &gt; 100 mIU/mL may follow a preemptive strategy, involving HBV DNA monitoring and starting prophylaxis only if antibody levels drop below the protective threshold. HBV vaccination is highly recommended for all nonimmune MS patients, with vaccine efficacy in MS patients appearing comparable to that of the general population.</p>}},
  author       = {{Buonomo, Antonio Riccardo and Viceconte, Giulio and Nicolini, Laura Ambra and Habibović, Selma and Rajan, Asha K. and Santos, Lurdes and Gherlan, George Sebastian and Miron, Victor Daniel and Şahin, Gülşen Özkaya and Săndulescu, Oana}},
  issn         = {{1746-0794}},
  keywords     = {{alemtuzumab; disease-modifying therapies; Hepatitis B virus; multiple sclerosis; ocrelizumab; potential occult HBV infection}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{187--196}},
  publisher    = {{Taylor & Francis}},
  series       = {{Future Virology}},
  title        = {{Management of hepatitis B virus (HBV) infection in multiple sclerosis patients on disease modifying therapies (DMTs)}},
  url          = {{http://dx.doi.org/10.1080/17460794.2025.2484834}},
  doi          = {{10.1080/17460794.2025.2484834}},
  volume       = {{20}},
  year         = {{2025}},
}