Enhanced HBV Vaccination Strategies Beneficial in IBD

TOPLINE:

Although hepatitis B virus (HBV) vaccination in patients with inflammatory bowel disease (IBD) shows only a 66.7% response rate, a majority of patients who fail to respond initially do eventually benefit from enhanced revaccination strategies. 

METHODOLOGY:

• Vaccination against HBV is recommended for all seronegative patients with IBD, but the response rates to standard vaccination schedules can be affected by factors such as immunosuppression.
• In this retrospective study conducted at five tertiary care centers in Greece, researchers assessed the efficacy of the standard three-dose HBV vaccination schedule in patients with IBD.
• Patients were tested for hepatitis B surface antigen and antibodies against hepatitis B surface antigen (anti-HBs) and core antigens at diagnosis. Anti-HBs > 10 mIU/mL was considered an adequate immune response, whereas for individuals on immunomodulators or antitumor necrosis factor (anti-TNF) alpha agents, a titer >100 mIU/mL was required.
• Patients with undetectable anti-HBs underwent the standard three-dose vaccination schedule (20 μg doses at 0, 1, and 6 months).
• Those not adequately responding to the standard schedule were offered a revaccination scheme with either an accelerated schedule (20 μg doses at 0, 1, and 2 months) or a double-dose schedule (40 μg doses at 0, 1, and 6 months).

TAKEAWAY:

• Of the 409 patients (mean age, 44.1 years; 46.2% women) who participated, 66.7% adequately responded to the baseline HBV vaccination, with 69.2% of the responders achieving anti-HBs > 100 mIU/mL.
• Factors significantly negatively affecting vaccine response included obesity (body mass index > 30), Crohn’s disease, extensive ulcerative colitis, extraintestinal manifestations, C-reactive protein levels > 3 mg/dL, and treatment with immunomodulators or anti-TNF alpha agents.
• Revaccination was effective in 58.2% of those who did not adequately respond to standard vaccination, with no significant difference between the accelerated and double-dose strategies.

IN PRACTICE:

“The need for screening and immunization for HBV in IBD patients should be strongly encouraged, ideally at diagnosis,” the authors wrote. “A revaccination approach in nonresponders should be offered, especially for patients who are about to start or already receive [immunomodulators] and/or anti-TNF alpha agents.” 

SOURCE:

The study, led by Panagiotis Markopoulos, MD, Metaxa Memorial Cancer Hospital, Piraeus, Greece, and Konstantinos Karmiris, MD, PhD, Venizeleio General Hospital, Heraklion, Greece, was published online in Inflammatory Bowel Diseases.

LIMITATIONS:

The study’s retrospective design may have introduced recall and selection bias. The lack of randomization and control groups may have impacted the reliability of the findings.

DISCLOSURES:

The study did not report any funding source. Some authors reported serving as speakers, consultants, lecturers, and advisory board members, and receiving advisor or lecture honoraria from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.