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OCRELIZUMAB THERAPY IN PATIENTS WITH ANTI-HBC ANTIBODIES - A PRELIMINARY STUDY
Natalia Niedziela1, Alicja Zimnol1, Michał Lubczyński1
1DEPARTMENT OF NEUROLOGY FACULTY OF MEDICAL SCIENCES IN ZABRZE, MEDICAL UNIVERSITY OF SILESIA, ZABRZE, POLAND.
Objective:
Aim: Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease resulting in cognitive impairment, physical disabilities, and neurological symptoms. Ocrelizumab is an effective drug used in MS treatment. However, it causes a risk of hepatitis B reactivation in anti-HBc positive patients. We describe the impact of entecavir and tenofovir on HBV reactivation during treatment with ocrelizumab.
Patients And Methods:
Materials and methods: Our study included eight patients (aged 18-70 years) with positive anti-HBc antibodies who were diagnosed with MS based on the 2017 McDonald criteria. The subjects were treated with ocrelizumab and were given anti-HBV prophylaxis with nucleoside analogs. The mean time from the beginning of therapy with nucleoside analogs to the initiation of ocrelizumab treatment was 27.5 days. Patients were administered ocrelizumab and none of them was diagnosed with HBV reactivation.
Results:
Results: None of the laboratory parameters worsened. No severe adverse effects were observed. These results suggest that entecavir and tenofovir are effective in HBV reactivation prophylaxis. Additionally, positive anti-HBc antibodies do not rule out treatment with ocrelizumab.
Conclusion:
Conclusions: In patients with positive anti-HBc antibodies, nucleoside analogs, such as entecavir or tenofovir, should be administered before ocrelizumab administration to reduce the risk of viral reactivation. Further studies on simultaneous treatment with ocrelizumab and nucleoside analogs are required to confirm our findings.
Insights
Nucleoside analogs like entecavir and tenofovir effectively prevent hepatitis B virus (HBV) reactivation in multiple sclerosis (MS) patients treated with ocrelizumab. Prophylaxis is recommended for anti-HBc positive individuals before ocrelizumab initiation.
Area of Science:
- Neurology
- Immunology
- Hepatology
Background:
- Multiple sclerosis (MS) is a neurodegenerative disease impacting cognition and physical function.
- Ocrelizumab is a key treatment for MS but carries a risk of hepatitis B virus (HBV) reactivation in patients with prior HBV exposure (anti-HBc positive).
Purpose of the Study:
- To evaluate the efficacy of entecavir and tenofovir in preventing HBV reactivation during ocrelizumab treatment for MS.
- To assess the safety and impact of nucleoside analog prophylaxis in anti-HBc positive MS patients.
Main Methods:
- Retrospective analysis of eight anti-HBc positive MS patients (aged 18-70) treated with ocrelizumab.
- Patients received prophylactic nucleoside analogs (entecavir or tenofovir) prior to ocrelizumab initiation, with a mean prophylaxis duration of 27.5 days.
- Monitoring for HBV reactivation and adverse events.
Main Results:
- No cases of HBV reactivation were observed in any of the patients.
- No significant worsening of laboratory parameters or severe adverse effects were reported.
- Entacavir and tenofovir demonstrated effectiveness in preventing HBV reactivation.
Conclusions:
- Nucleoside analog prophylaxis (entecavir or tenofovir) is effective in preventing HBV reactivation in anti-HBc positive MS patients undergoing ocrelizumab therapy.
- Anti-HBc positivity should not preclude ocrelizumab treatment when appropriate prophylaxis is administered.
- Further research into simultaneous ocrelizumab and nucleoside analog treatment is warranted.
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