Response to hepatitis B vaccine in patients with multiple sclerosis: preliminary data

Background Studies in different autoimmune pathologies report a lower response rate (immunogenicity) to vaccinations than in the general population. Our objective is to analyze the immunogenicity of the vaccine against hepatitis B virus (HBV) in patients with multiple sclerosis (MS). Methods In a single prospective cohort of MS patients with negative HBV serology, hepatitis B (rDNA) B vaccine was administered at 0, 1 and 6 months. Immunogenicity was analyzed by the determination of antibodies to surface antigens of HBV. We considered a patient as a responder if antibodies level was higher than 10 IU/L. Posterior analysis of immunogenicity was conducted by demographic variables (e.g. MS phenotype, EDSS) and use of disease-modifying drugs (DMTs). Results Vaccination study of 251 patients: 160 of them were sero-negative (63.7%). Patients vaccinated: 99. Overall response: 74.1%. No significant relationship by sex (female 77.6% responders, male 68.8%) and MS phenotype (relapsing forms 74.3% responders, secondary progressive 50%). Variables associated with significantly lower immunogenicity were: age (>55 years), EDSS score (median: non-responders=3.0, responders=1.0), number of relapses and treatment with fingolimod (28.6% responders, n=7). Anti-CD20 therapies showed lower vaccine response (50%), but were not very represented in our sample (n=2). Immunogenicity with other DMTs: interferon/glatiramer 69.6% (n=23), teriflunomide 71.4% (n=14), dimethylfumarate 92.3% (n=13), natalizumab 100% (n=7). Conclusion The overall immunogenicity of our sample is lower than that reported in the general population (74 vs >86%), as in other autoimmune diseases. Preliminary data show a lower immunogenicity with older age, higher EDSS score, number of relapses and fingolimod use.