Markopoulos Panagiotis, Karmiris Konstantinos, Dimas Ioannis, Voudoukis Evangelos, Siakavellas Spyridon, Axiaris Georgios, Zacharopoulou Eirini, Zampeli Evanthia, Tsironi Eftychia, Tzouvala Maria, Papatheodoridis Georgios, Bamias Georgios
Department of Gastroenterology, Metaxa Memorial Cancer Hospital, Piraeus, Greece.
Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece.
Inflamm Bowel Dis. 2025 May 12;31(5):1317-1324. doi: 10.1093/ibd/izae173.
Patients with inflammatory bowel disease (IBD) exhibit an increased risk for acquiring hepatitis B virus (HBV), thus they should be vaccinated preferably, if not already infected or immunized. We assessed the efficacy of HBV vaccination in IBD patients and impact of different factors on the immune response. We also evaluated the success rate of 2 different revaccination strategies in the nonresponders.
This was a retrospective observational cohort study carried out in 5 tertiary centers. All patients were tested for hepatitis B surface antigen, antibodies against hepatitis B surface antigen (anti-HBs), and antibodies against hepatitis B core antigen. Patients tested negative and underwent the standard schedule with 20 µg at 0, 1, and 6 months. Nonresponders (anti-HBs <10 IU/L) were offered a revaccination scheme with either 3 doses of 40 µg at 0, 1, and 6 months or an accelerated scheme with 20 µg at 0, 1, and 2 months.
A total of 409 patients were included, and 273 (66.7%) of those (females: 49.5%; Crohn's disease [CD]: 56.7%) responded to baseline vaccination. A total of 189 (69.2%) of 273 (females: 48.1%; CD: 60.3%) developed anti-HBs >100 IU/L. Body mass index <30 kg/m2 (P = .017) was positively associated, while diagnosis of CD (P = .013), extensive UC (P <.0001), extraintestinal manifestations (P = .001), and treatment with immunomodulators/anti-tumor necrosis factor (P < .00) negatively affected the response. Revaccination was offered to 103 patients, and 58.3% of them achieved anti-HBs >10 IU/L. Both revaccination strategies were equally effective.
IBD patients demonstrate lower response to HBV vaccination compared with the general population. Age, body mass index, type, disease activity, and immunosuppression negatively affect the response. Half of nonresponders may benefit from an enhanced revaccination attempt.
炎症性肠病（IBD）患者感染乙型肝炎病毒（HBV）的风险增加，因此，若尚未感染或免疫，他们应优先接种疫苗。我们评估了IBD患者中HBV疫苗接种的效果以及不同因素对免疫反应的影响。我们还评估了两种不同的再次接种策略在无反应者中的成功率。
这是一项在5个三级中心开展的回顾性观察队列研究。所有患者均检测了乙型肝炎表面抗原、乙型肝炎表面抗原抗体（抗-HBs）和乙型肝炎核心抗原抗体。检测为阴性的患者按标准程序在0、1和6个月时接种20μg疫苗。无反应者（抗-HBs<10IU/L）接受再次接种方案，即在0、1和6个月时接种3剂4μg，或在0、1和2个月时接种20μg的加速方案。
共纳入409例患者，其中273例（66.7%）（女性：49.5%；克罗恩病[CD]：56.7%）对基线疫苗接种有反应。273例中有189例（69.2%）（女性：48.1%；CD：60.3%）抗-HBs>100IU/L。体重指数<30kg/m²（P = 0.017）呈正相关，而CD诊断（P = 0.013）、广泛性溃疡性结肠炎（P<0.0001）、肠外表现（P = 0.001）以及使用免疫调节剂/抗肿瘤坏死因子治疗（P<0.00）对反应有负面影响。103例患者接受了再次接种，其中58.3%的患者抗-HBs>10IU/L。两种再次接种策略同样有效。
与普通人群相比，IBD患者对HBV疫苗接种的反应较低。年龄、体重指数、类型、疾病活动度和免疫抑制对反应有负面影响。一半的无反应者可能从加强的再次接种尝试中获益。
