The Risk of Hepatitis B and Tuberculosis Reactivation in Patients with Neuromyelitis Optica Spectrum Disorder Treated with B-Cell Depletion Therapy
Xi Wang1, Rui Li1, Shengfei Hu1
1Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University
Objective:

This study aims to evaluate the risk of hepatitis B or tuberculosis reactivation in neuromyelitis optica spectrum disorder (NMOSD) patients with potential occult hepatitis B virus (HBV) infection (pOBI) or latent tuberculosis infection (LTBI) undergoing B-cell depletion therapy, providing evidence for clinical decision-making.

Background:

Currently, there are no established guidelines regarding the necessity of prophylactic anti-HBV or antituberculosis treatment for NMOSD patients with pOBI or LTBI undergoing B-cell depletion therapy. Data on the risk of hepatitis B or tuberculosis reactivation in these patients is limited.

Design/Methods:

We selected 102 NMOSD patients treated with inebilizumab or rituximab between January 1, 2016, and August 31, 2024. Liver function tests, HBV serology tests, and interferon-gamma release assay (IGRA) were performed to identify pOBI or LTBI. For pOBI patients, liver function, HBV serology, and HBV-DNA were continuously monitored to ascertain hepatitis B reactivation. For LTBI patients, IGRA was tested during subsequent treatments, and clinical and radiographic manifestations were used to assess tuberculosis reactivation. 

Results:
Among the 102 NMOSD patients, 40 (39.2%) patients had pOBI. After consultation with infectious disease specialists and considering patient preferences, 11 pOBI patients received prophylactic anti-HBV therapy. The remaining pOBI patients were continuously monitored for HBV serology, HBV-DNA, and liver function. During a median follow-up of 12 months (6.25-25 months), all patients tested negative for HBV-DNA, and no cases of active hepatitis occurred. Similarly, 9 (8.8%) patients with LTBI did not received prophylactic antituberculosis treatment. During a median follow-up of 11 months (7-17 months), no evidence of active tuberculosis was found. 
Conclusions:

The risk of hepatitis B or tuberculosis reactivation appears to be low in NMOSD patients with pOBI or LTBI undergoing B-cell depletion therapy, even without prophylactic treatment. Regular monitoring and timely initiation of targeted treatment upon evidence of reactivation may be a more reasonable strategy.

10.1212/WNL.0000000000210457
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