- Fecal Incontinence
|Antibody Response to Hepatitis B Virus Vaccine is Impaired in Patients With Inflammatory Bowel Disease on Infliximab Therapy
Pratt PK Jr1, David N2, Weber HC2, Little FF3, Kourkoumpetis T4, Patts GJ5, Weinberg J5, Farraye FA2. Inflamm Bowel Dis. 2018 Jan 18;24(2):380-386. doi: 10.1093/ibd/izx001.
1 Department of Internal Medicine, Boston University Medical Center, Boston, MA.
2 Section of Gastroenterology, Boston University Medical Center, Boston, MA.
3 Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University Medical Center, Boston, MA.
4 Department of Gastroenterology, Baylor College of Medicine, Houston, TX.
5 Department of Biostatistics, Boston University School of Public Health, Boston, MA.
BACKGROUND: Studies have demonstrated an association between anti-TNF/immunomodulator agents used in inflammatory bowel disease (IBD) and impaired hepatitis B virus (HBV) vaccine immunogenicity, but little data exist on whether specific medication types affect protective HBsAb titers. Our aim was to analyze this association.
METHODS: This is a retrospective cohort study. Inclusion criteria: age ≥18, diagnosis of Crohn's disease (CD) or ulcerative colitis (UC), previous HBV vaccination series and/or ≥1 positive HBsAb, and record of IBD therapy in 6 months before titer level. Patients were stratified based upon medication exposures: anti-TNF, immunomodulator, combination anti-TNF and immunomodulatory, and a reference arm. Titer levels following vaccination and specific medication types given in the 6 months before titer were recorded. Seroprotection was defined as HBsAb ≥10 IU/l and ≥100 IU/l.
RESULTS: The study cohort (N = 391) was 70.8% white, 51.4% female and 64.2% had CD and 35.8% had UC. The mean age was 45.8 years. A significantly lower percentage of patients exposed to anti-TNF, immunomodulator or dual therapy had titers ≥10 (P < 0.01). Regarding specific medications, only patients exposed to infliximab (P < 0.01) were less likely to have titer levels ≥10, after controlling for other medication exposures, age at titer level, and interval time between vaccination/titer level. This was not found for patients exposed to adalimumab, methotrexate, 6-mercaptopurine, or azathioprine.
CONCLUSIONS: Patients exposed to infliximab were significantly less likely to have protective HBsAb titer levels following vaccination, a trend not seen in patients on adalimumab. Efforts to vaccinate IBD patients against HBV before use of immunomodulators and anti-TNFs, infliximab specifically, and screen periodically thereafter must be reinforced.