Effect of the Number of Vaccine Doses Before Starting Anti-CD20 Therapy on Seroprotection Rates Against Hepatitis B Virus in People With MS

Data:	2025
Descripció:	11 pàg.
Resum:	BACKGROUND AND OBJECTIVES: Hepatitis B vaccination (HBV) requires 6 months to complete and is recommended for patients with multiple sclerosis (PWMS), particularly those who are candidates for anti-CD20 therapy. However, limited data exist on HBV immunogenicity in PWMS receiving disease-modifying therapies (DMTs) and the impact of starting anti-CD20 therapy during immunization. We aimed to evaluate HBV immunogenicity in PWMS starting anti-CD20 therapy during vaccination, focusing on the number of doses received before anti-CD20 initiation. METHODS: We conducted a retrospective analysis of a prospective cohort of adult PWMS at a single center in Spain, from April 2015 to May 2023. Eligible participants completed a 4-dose HBV course and underwent postvaccination serologic testing. We assess seroprotection rates (SRs), defined as the percentage of patients achieving anti-hepatitis B surface antibody titers ≥10 IU/L, focusing on those who switched to anti-CD20 therapy during vaccination, based on doses received before starting anti-CD20 and type of DMT at vaccination start. A multivariate generalized linear model (GLM) was used to identify factors associated with higher seroconversion. RESULTS: A total of 289 PWMS (median [interquartile range (IQR)] age, 47. 7 [42. 8-54. 4] years; 65. 7% female; median [IQR] disease duration, 14. 8 [6. 7-21. 2] years) were included. SRs progressively declined with fewer doses before anti-CD20 initiation, from 92. 8% (95% CI 87. 1-96. 5) for 4 doses to 24. 0% (95% CI 9. 4-45. 1) for 1 dose. Patients transitioning from sphingosine 1-phosphate (S1P) modulators showed the lowest SR at 25. 0% (95% CI 7. 3-52. 4). The multivariate GLM confirmed these findings, with 3 doses (SR ratio 3. 23 [95% CI 1. 68-6. 23]; p = 0. 0005) or 4 doses (SR ratio 3. 76 [95% CI 1. 96-7. 24]; p < 0. 0001) before anti-CD20 therapy significantly associated with higher SRs, while starting S1P modulators at vaccination onset was significantly associated with lower SRs (SR ratio 0. 42 [95% CI 0. 23-0. 78]; p = 0. 0058). Female sex (SR ratio 1. 15 [95% CI 1. 01-1. 32]; p = 0. 0389) and younger age (SR ratio 0. 90 [95% CI 0. 83-0. 97]; p = 0. 0036) were also significantly associated with higher SRs. DISCUSSION: Initiating anti-CD20 therapy during HBV negatively affects SRs, with a direct correlation with the number of doses received before anti-CD20 initiation. Early planning and execution of required vaccinations are crucial in managing PWMS. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that HBV during initiation of anti-CD20 therapy is less effective in establishing seroprotection to hepatitis B than in patients in whom HBV is completed before initiation of anti-CD20 therapy.
Ajuts:	Instituto de Salud Carlos III PI19/01606
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Neurology, Vol. 104, Núm. 3 (February 2025) , ISSN 1526-632X

DOI: 10.1212/WNL.0000000000210281
PMID: 39819099

11 p, 750.4 KB

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