Reactivation of Hepatitis B Virus With Immune-Escape Mutations After Ocrelizumab Treatment for Multiple Sclerosis

Maria R Ciardi; Marco Iannetta; Maria A Zingaropoli; Romina Salpini; Marianna Aragri; Rosanna Annecca; Simona Pontecorvo; Marta Altieri; Gianluca Russo; Valentina Svicher; Claudio M Mastroianni; Vincenzo Vullo

doi:10.1093/ofid/ofy356

Reactivation of Hepatitis B Virus With Immune-Escape Mutations After Ocrelizumab Treatment for Multiple Sclerosis

Open Forum Infect Dis. 2018 Dec 26;6(1):ofy356. doi: 10.1093/ofid/ofy356. eCollection 2019 Jan.

Affiliations

¹ Department of Public Health and Infectious Diseases, Sapienza, University of Rome, Rome, Italy.
² Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
³ Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.

Abstract

Ocrelizumab is an anti-CD20 monoclonal antibody for the treatment of multiple sclerosis (MS) that is closely related to rituximab. We describe a case of hepatitis B virus (HBV) reactivation in an MS patient with resolved HBV infection receiving ocrelizumab. HBV reactivation was monitored with HBV-DNA and HBV surface antigen periodic assessment. Anti-HBV treatment with entecavir was started after HBV-DNA detection. Ocrelizumab can reactivate viral replication in patients with resolved HBV infection. HBV reactivation monitoring seems an effective and safe option for the management of these patients. More studies are needed to assess the optimal management of HBV reactivation in MS patients on ocrelizumab treatment.

Keywords: CD20; HBV; biologics; entecavir; liver; prophylaxis.

Publication types

Case Reports