Cost‐effective and safe ambulatory long‐term immunoprophylaxis with intramuscular instead of intravenous hepatitis B immunoglobulin to prevent reinfection after orthotopic liver transplantation

Abstract

Long-term administration of i.m. HBIG saves up to 60% of the usual costs for i.v. prophylaxis of HBV reinfection in patients after OLT. In combination with lamivudine, long-term i.m. HBIG therapy is as efficient as i.v. HBIG treatment, but its lower costs clearly favour its use in preventing HBV reinfection after OLT.

Safety and Efficacy of Subcutaneous Hepatitis B Immunoglobulin After Liver Transplantation: An Open Single-Arm Prospective Study

“…Longterm prophylaxis with high-dose IV HBIG had been the standard of care to prevent HBV reinfection after LT until the introduction of lamivudine. Afterwards, several studies have shown that combining lower HBIG doses with lamivudine reduced reinfection rates to less than 5% (7)(8)(9)(10)(11)(12)(13)(14). This strategy allowed the reduction of HBIG doses probably because lamivudine blocked viral replication of occult HBV foci reducing HBIG consumption.…”

“…This strategy allowed the reduction of HBIG doses probably because lamivudine blocked viral replication of occult HBV foci reducing HBIG consumption. The switch from IV to IM administration of HBIG is cost saving and improves flexibility of patient in his daily life (15,16). However, patients treated with IM HBIG compared to patients treated with IV HBIG had worse quality of life score on the side effects scale (16).…”

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“…However, intramuscular administration involves a painful injection. 20 The combination of HBIg and NAs is more effective against HBV reinfection after liver transplant than HBIg alone, because of synergistic activity; the combination results in a greater reduction in the needed time course and doses of HBIg. 11,21 The combination of HBIg and lamivudine has been the standard of care recommended by many centers against HBV reinfection, with recurrence rate of less than 10% at 2 years after liver transplant.…”

Controversies Regarding the Hepatitis B Immune Globulin Prophylaxis (HBIG) for Liver Transplantation Recipients

“…Angus/2008 [32] Avolio/2008 [106] Angus/2000 [51] Anselmo/2002 [33] Anderson/2007 [107] Alonso/2003 [108] Brock/2011 [109] Buti/2003 [110] Ben-Ari/2004 [111] Chun/2010 [112] Dadson/2000 [113] Dehghani/2013 [114] Dickson/2006 [59] Dumortier/2003 [115] Degertekin/2010 [116] Di Paolo/2004 [117] Faust/2003 [118] Freshwater/2008 [99] Fabrega/2003 [119] Feretti/2004 [120] Filipponi/2010 [121] Gane/2013 [55] Han/2000 [35] Han/2003 [122] Honaker/2002 [123] Iacob/2008 [124] Jiang/2010 [125] Jain/2005 [126] Jiao/2007 [127] Karademir/2006 [128] Kwon/2006 [129] Lee/2000 [130] Lee/2004 [131] Lu/2004 [85] Lu/2008 [39] Loss/2003 [132]…”