Abstract
To evaluate the response to hepatitis B virus (HBV) vaccine in patients on biological therapy. Adults with autoimmune inflammatory diseases on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included. Hepatitis B surface antibody (anti-HBs) was measured by ELISA before and after vaccination. Seroconversion was considered when an anti-HBs titer > 10 mIU/mL was achieved. The effect of treatment on the immunoprotective state was studied. The response was compared with that obtained in patients on synthetic disease modifying anti-rheumatic drugs (DMARDs) and healthy controls. A total of 187 patients on biologicals, 48 on synthetic DMARDs, and 49 on healthy controls were analyzed. More than 80% of patients on biologics responded to the vaccine but required more boosters and second vaccine series. Patients who achieved seroconversion were younger than those who did not (47.10 ± 12.99 vs. 53.18 ± 10.54 years, p = 0.012). Being on etanercept or golimumab was associated with seroconversion, while being on rituximab was not. Seroconversion was achieved in 93.75% of patients on synthetic DMARDs and 97.96% of healthy controls. The seroconversion rate in the biologics group was lower than in the synthetic DMARD group (p = 0.043) and tended to be lower than in the healthy group (p = 0.056). In patients on biological therapy, a high rate of HBV vaccine response can be achieved when a complete vaccination schedule is administered. Vaccination while not on biological agents reduces the requirement for boosters and revaccination.
Key points: • Patients on biological therapy can achieve high rates of immune response to HBV vaccine when complete vaccination schedules are administered. • However, to achieve such a high seroconversion rate, more boosters and second vaccination series are required. • This supports the proposal already made to provide HBV vaccination to all patients with an autoimmune inflammatory disease after the diagnosis is made and not when the use of a biological treatment is under consideration. |
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References
Elkayam O, Yaron M, Caspi D (2002) Safety and efficacy of vaccination against hepatitis B in patients with rheumatoid arthritis. Ann Rheum Dis 61:623–625
Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M et al (2019) 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2019-215882
Singh JA, Saag KG, Bridges SL, Akl EA, Bannuru RR, Sullivan MC et al (2016) 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis: ACR RA treatment recommendations. Arthritis Care Res 68:1–25
Pratt PK, David N, Weber HC, Little FF, Kourkoumpetis T, Patts GJ, Weinberg J, Farraye FA (2018) Antibody response to hepatitis B virus vaccine is impaired in patients with inflammatory bowel disease on infliximab therapy. Inflamm Bowel Dis 24:380–386
Rahier JF, Magro F, Abreu C, Armuzzi A, Ben-Horin S, Chowers Y, Cottone M, de Ridder L, Doherty G, Ehehalt R, Esteve M, Katsanos K, Lees CW, Macmahon E, Moreels T, Reinisch W, Tilg H, Tremblay L, Veereman-Wauters G, Viget N, Yazdanpanah Y, Eliakim R, Colombel JF, European Crohn’s and Colitis Organisation (ECCO) (2014) Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 8:443–468
Intongkam S, Samakarnthai P, Pakchotanon R, Narongroeknawin P, Assavatanabodee P, Chaiamnuay S (2018) Efficacy and safety of hepatitis B vaccination in rheumatoid arthritis patients receiving disease-modifying antirheumatic drugs and/or biologics therapy. J Clin Rheumatol. https://doi.org/10.1097/RHU.0000000000000877
Gisbert JP, Villagrasa JR, Rodríguez-Nogueiras A, Chaparro M (2012) Efficacy of hepatitis B vaccination and revaccination and factors impacting on response in patients with inflammatory bowel disease. Am J Gastroenterol 107:1460–1466
Jiang H-Y, Wang S-Y, Deng M, Li Y-C, Ling Z-X, Shao L, Ruan B (2017) Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: a systematic review and meta-analysis. Vaccine 35:2633–2641
Lunel-Fabiani F, Masson C, Ducancelle A (2014) Systemic diseases and biotherapies: understanding, evaluating, and preventing the risk of hepatitis B reactivation. Joint Bone Spine 81:478–484
Szczygielska I, Hernik E, Kwiatkowska M, Rutkowska-Sak L, Kołodziejczyk B, Gazda A (2015) Assessment of the level of vaccine-induced anti-HBs antibodies in children with inflammatory systemic connective tissue diseases treated with immunosuppression. Reumatologia 53:56–60
Hepatitis B Foundation (2019) Vaccine non-responders. http://www.hepb.org/prevention-and-diagnosis/vaccination/vaccine-non-responders/. Accessed 23 October 2019
Funding
This study was funded by Sociedad de Reumatología Comunidad de Madrid (SORCOM)/MSD and Pfizer. The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or in the decision to submit the manuscript for publication.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Patricia Richi, Oriol Alonso, María Dolores Martín, Laura González-Hombrado, Teresa Navío, Marina Salido, Jesús Llorente, Cristina Andreu-Vázquez, Cristina García-Fernández, Ana Jiménez-Diaz, Leticia Lojo, Laura Cebrián, IsraelThuissard-Vasallo, María José Martínez de Aramayona, Tatiana Cobo, Marta García-Castro, Patricia Castro, Mónica Fernández-Castro, Óscar Illera, Martina Steiner, and Santiago Muñoz-Fernández. Patricia Richi wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Patricia Richi declares she has received research grants from Sociedad de Reumatología Comunidad de Madrid (SORCOM)/MSD and Pfizer. Santiago Muñoz-Fernández declares he has received research grants from Sociedad de Reumatología Comunidad de Madrid (SORCOM)/MSD and Pfizer. The rest of authors declare that they have no conflict of interest.
The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or in the decision to submit the manuscript for publication.
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Richi, P., Alonso, O., Martín, M.D. et al. Evaluation of the immune response to hepatitis B vaccine in patients on biological therapy: results of the RIER cohort study. Clin Rheumatol 39, 2751–2756 (2020). https://doi.org/10.1007/s10067-020-05042-2
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DOI: https://doi.org/10.1007/s10067-020-05042-2