HBV Vaccination in IBD: Revaccination Boosts Response in Non-Responders

TOPLINE: Hepatitis B virus (HBV) vaccination in inflammatory bowel disease (IBD) patients shows a 66.7% initial response rate. However, most patients who do not respond to the initial vaccination benefit from enhanced revaccination strategies.

METHODOLOGY: While HBV vaccination is recommended for all seronegative IBD patients, response rates can be impacted by immunosuppression. In this Greek retrospective study conducted at five tertiary care centers, researchers evaluated the efficacy of the standard three-dose HBV vaccination schedule in IBD patients. Participants were tested for hepatitis B surface antigen and antibodies against hepatitis B surface antigen (anti-HBs) at diagnosis. An anti-HBs level > 10 mIU/mL was deemed an adequate response, while a titer > 100 mIU/mL was needed for patients on immunomodulators or anti-TNF alpha agents. Patients with undetectable anti-HBs levels underwent the standard three-dose vaccination (20 μg doses at 0, 1, and 6 months). Those who did not respond adequately were offered either an accelerated (20 μg doses at 0, 1, and 2 months) or double-dose schedule (40 μg doses at 0, 1, and 6 months).

TAKEAWAY: Among 409 patients (mean age: 44.1 years; 46.2% women), 66.7% responded to baseline HBV vaccination, with 69.2% of responders achieving anti-HBs levels > 100 mIU/mL. Factors negatively affecting response included obesity (BMI > 30), Crohn’s disease, extensive ulcerative colitis, extraintestinal manifestations, high C-reactive protein levels (> 3 mg/dL), and treatment with immunomodulators or anti-TNF alpha agents. Revaccination proved effective in 58.2% of non-responders, with no significant difference between the accelerated and double-dose strategies.

IN PRACTICE: The authors emphasized the importance of screening and immunizing IBD patients for HBV, ideally at diagnosis. Revaccination should be offered to non-responders, especially those on or about to start immunomodulators and/or anti-TNF alpha therapy.

SOURCE: The study, led by Panagiotis Markopoulos, MD, from Metaxa Memorial Cancer Hospital, and Konstantinos Karmiris, MD, PhD, from Venizeleio General Hospital, was published in Inflammatory Bowel Diseases.

LIMITATIONS: The retrospective design may have introduced bias, and the absence of randomization and control groups could have influenced the findings’ reliability.

DISCLOSURES: No funding sources were reported. Some authors disclosed relationships with pharmaceutical companies through speaking engagements, consulting, and advisory board memberships.

Enhanced HBV Vaccination Strategies Beneficial in Patients With IBD — Medscape — September 06, 2024.