Andrade Patrícia, Santos-Antunes João, Rodrigues Susana, Lopes Susana, Macedo Guilherme
Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal.
Department of Biochemistry (U38-FCT), Faculty of Medicine, University of Porto, Portugal.
J Gastroenterol Hepatol. 2015 Nov;30(11):1591-5. doi: 10.1111/jgh.13001.
Immunization against hepatitis B virus (HBV) infection is recommended in patients with inflammatory bowel disease (IBD), particularly in those under immunosuppressive therapy. Limited data are available about IBD patient's response to HBV vaccination. We assessed the response rate to HBV vaccination in IBD patients and evaluated the impact of different factors on the efficacy of HBV vaccination.
Anti-HBs titers were measured in a cohort of IBD patients under treatment with infliximab and/or azathioprine. Vaccination was considered efficient when anti-HBs titers were higher than 10 IU/L.
We have identified 217 patients with IBD under infliximab who were vaccinated for hepatitis B, 172 (79%) with Crohn's Disease and the remaining with ulcerative colitis; 114 patients (53%) were male and mean age was 33 ± 11 years. Overall, HBV vaccine was successful in 164 (76%) patients. Only 14 patients were vaccinated after infliximab was initiated, and only two of them had antibody levels above 10 IU/L. Among the patients that received vaccination before the beginning of infliximab, 88% of those who were vaccinated before starting azathioprine developed antibodies in contrast to 55% who already were under azathioprine. In multivariable analysis, treatment with infliximab (adjusted OR [95% CI]: 17.642 [8.514-33.937]) and with azathioprine (adjusted OR [95% CI]: 3.344 [1.653-9.145]) were the only factors associated with weaker response to HBV vaccination.
The response rate to the standard HBV vaccination in IBD patients is low mainly in those treated with infliximab and/or azathioprine.
推荐炎症性肠病（IBD）患者接种乙肝病毒（HBV）疫苗，尤其是接受免疫抑制治疗的患者。关于IBD患者对HBV疫苗接种的反应的数据有限。我们评估了IBD患者对HBV疫苗接种的反应率，并评估了不同因素对HBV疫苗接种效果的影响。
在一组接受英夫利昔单抗和/或硫唑嘌呤治疗的IBD患者中检测抗-HBs滴度。当抗-HBs滴度高于10 IU/L时，疫苗接种被认为是有效的。
我们确定了217例接受英夫利昔单抗治疗并接种乙肝疫苗的IBD患者，其中172例（79%）为克罗恩病患者，其余为溃疡性结肠炎患者；114例（53%）为男性，平均年龄为33±11岁。总体而言，164例（76%）患者的HBV疫苗接种成功。仅14例患者在开始使用英夫利昔单抗后接种疫苗，其中只有2例抗体水平高于10 IU/L。在英夫利昔单抗开始使用前接种疫苗的患者中，在开始使用硫唑嘌呤前接种疫苗的患者中有88%产生了抗体，而已经在使用硫唑嘌呤的患者中这一比例为55%。在多变量分析中，使用英夫利昔单抗治疗（调整后的OR[95%CI]：17.642[8.514-33.937]）和使用硫唑嘌呤治疗（调整后的OR[95%CI]：3.344[1.653-9.145]）是与HBV疫苗接种反应较弱相关的唯一因素。
IBD患者对标准HBV疫苗接种的反应率较低，主要是在接受英夫利昔单抗和/或硫唑嘌呤治疗的患者中。
