The use of antiCD20 antibody monotherapy is not associated with hepatitis B virus (HBV) reactivation (HBVr) in patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS), according to a study published in the Journal of Neurology.

During the study, none of the 28 patients who had previously resolved HBV infection experienced HBVr or changes in HBV surface antigen (HBsAg) levels. Patients had a median follow-up of 3.1 years, which accounted for 83.6 patient-years of antiCD20 antibody monotherapy without any antiviral prophylaxis.

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“In summary, in our cohort antiCD20 monoclonal treatment used in monotherapy was not associated with risk of HBV reactivation in subjects with resolved HBV infection and multiple sclerosis or diseases of the spectrum of optic neuromyelitis at medium-term follow-up, despite the lack of antiviral prophylaxis,” the authors wrote.

Most patients in the study cohort (89.3%) had previously received at least 1 immunomodulatory therapy before receiving antiCD20 treatment. The most common prior treatments were corticosteroids (82.1%) and interferon (42.9%).

A total of 540 patients with NMOSD or MS who received antiCD20 antibody treatment were initially screened at the Centre d’Esclerosi Múltiple de Catalunya as part of the HEBEM prospective study. 

Of these patients, only 28 (5.2%) were identified as having a previously resolved HBV infection and were included in the analyses. Rituximab was utilized for 22 patients, and ocrelizumab was given to the other 6. In general, antiHBc-positive patients were older than the rest treated patients (53.9 years versus 46.2 years; P <0.001). 

During the study, resolved HBV infection was determined as patients with positive tests for the HBV core antigen but negative for HBsAg and undetectable HBV-DNA levels. Patients were monitored for changes in HBsAg, alanine transaminase, and HBV-DNA levels every 6 months to rule out HBVr.


Marzo B, Vidal-Jordana A, Castilló J, et al. Hepatitis B reactivation is a rare event among patients with resolved infection undergoing anti-CD20 antibodies in monotherapy without antiviral prophylaxis: results from the HEBEM study. J Neurol. Published online September 11, 2023. doi:10.1007/s00415-023-11973-y