Adherence to Recommended Immunization Schedules in Patients with Inflammatory Bowel Disease on Biologics and Small Molecule Therapies

Shehab, Mohammad; Almatar, Ranim; Almohammad, Rawan; Alfadhli, Ahmad

doi:10.3390/gastroent14030028

Cited by 1 publication

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“…Furthermore, immunosuppressive medications of all types may lead to reactivation of HBV replication in patients with chronic HBV infection [39,40]. The HBV vaccine is effective, and the mainstay control of HBV is to prevent infection and consequent acute and chronic liver disease; however, patient adherence can be low [40][41][42]. Guidelines by the American Association for the Study of Liver Disease (AASLD) and the CDC recommend HBV screening and vaccination for any person seeking protection from hepatitis B, and also for those requiring immunosuppression (including IBD patients on steroids > 20 mg/d for 2 weeks or more, high-dose purine analogs, and other immunosuppressive agents such as TNF inhibitors) [43,44].…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study

Shehab,

Alrashed,

Alyaseen

et al. 2024

Vaccines

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Introduction: Hepatitis B virus (HBV) infection has been associated with chronic hepatitis and cirrhosis. Patients with inflammatory bowel disease (IBD) may be at a higher risk of HBV infection reactivation, especially those on biologic therapies. This study intends to compare the effectiveness of the HBV vaccine in patients with ulcerative colitis (UC) on infliximab (IFX) compared to those on 5-aminosalicylic acid (5-ASA). Methods: Patients with UC aged >18 years old were prospectively enrolled in the study. The patients were divided into two groups: patients treated with 5-ASA (control group) and patients treated with IFX (study group). HBV vaccination was administered (20 mcg) following the standard regimen, and Hepatitis B serum antibody (HbsAb) titers were assessed three months after the final dose. The response to HBV vaccines was categorized as an ‘adequate’ immune response (≥10 IU/L) and ‘effective’ immune response (≥100 IU/L). Results: In our final analysis of 118 patients with UC, 54.2% were male and 52.5% had extensive colitis. HBsAb titer levels were significantly higher in the 5-ASA group (126.7 ± 37.5) compared to the IFX group (55.5 ± 29.4). Stratifying HBsAb levels into two categories (≥10–99 IU/L and ≥100 IU/L) revealed a significantly greater proportion of subjects in the 5-ASA group with levels ≥100 IU/L compared to the IFX group (76.7% vs. 12.1%, p < 0.001). Logistic regression analysis demonstrated that patients with UC receiving 5-ASA were 23.94 times more likely to exhibit HBsAb levels ≥ 100 compared to those treated with IFX (OR = 23.94, 95% CI 8.89–64.49). Conclusion: The immune response to hepatitis B vaccination in patients with ulcerative colitis treated with IFX is attenuated compared to those treated with 5-ASA. Therefore, emphasizing the importance of HBV vaccination for patients with IBD before starting anti-TNF therapy, especially IFX, and advocating for screening is imperative in high-risk countries. Determining what levels of HBsAb provide protection and what happens to the levels over time after a booster dose are important clinical questions to be answered by follow-up studies.

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