Effect of Oral Levamisole Supplementation to Hepatitis B Vaccination on the Rate of Immune Response in Chronic Hemodialysis Patients

Aylı, Meltem; Ensari, Cüneyt; Mandıroğlu, Fahri; Mut, Suat

doi:10.1159/000045598

Cited by 21 publications

(13 citation statements)

References 8 publications

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“…Based on these molecular mechanisms, several clinical studies have shown that when administered together with certain vaccines such as HBV and tetanus-diphtheria, levamisole can improve seroprotection in patients with ESRD on HD (78798081), whereas a few other studies did not show a beneficial effect (8283). Moreover, a meta-analysis of four studies (328 patients) showed that the oral administration of levamisole at a dose of 80~120 mg for 4~6 months significantly increased seroconversion after HBV vaccination (75).…”

Section: Modulation Of DC Function In Patients With Esrdmentioning

confidence: 99%

Dendritic Cell Dysfunction in Patients with End-stage Renal Disease

Kim

et al. 2017

Immune Netw

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End-stage renal disease (ESRD) with immune disorder involves complex interactions between the innate and adaptive immune responses. ESRD is associated with various alterations in immune function such as a reduction in polymorphonuclear leukocyte bactericidal activity, a suppression of lymphocyte proliferative response to stimuli, and a malfunction of cell-mediated immunity at the molecular level. ESRD also increases patients' propensity for infections and malignancies as well as causing a diminished response to vaccination. Several factors influence the immunodeficiency in patients with ESRD, including uremic toxins, malnutrition, chronic inflammation, and the therapeutic dialysis modality. The alteration of T-cell function in ESRD has been considered to be a major factor underlying the impaired adaptive cellular immunity in these patients. However, cumulative evidence has suggested that the immune defect in ESRD can be caused by an Ag-presenting dendritic cell (DC) dysfunction in addition to a T-cell defect. It has been reported that ESRD has a deleterious effect on DCs both in terms of their number and function, although the precise mechanism by which DC function becomes altered in these patients is unclear. In this review, we discuss the effects of ESRD on the number and function of DCs and propose a possible molecular mechanism for DC dysfunction. We also address therapeutic approaches to improve immune function by optimally activating DCs in patients with ESRD.

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Section: Modulation Of DC Function In Patients With Esrdmentioning

confidence: 99%

Dendritic Cell Dysfunction in Patients with End-stage Renal Disease

Kim

et al. 2017

Immune Netw

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“…Second group had double dose (40 μg) whereas group 3 received a single dose plus 120 mg levamisole and group 4 received a double dose plus 120 mg levamisole. As a result, they discovered that there was no significant difference between a double dose and a single dose vaccination considering the antibody response and there was mention of a long term application of levamisole having salient effects when added to the HBV vaccination without any serious side effects (39). …”

Section: Resultsmentioning

confidence: 99%

Levamisole Usage as an Adjuvant to Hepatitis B Vaccine in Hemodialysis Patients, Yes or No?

Sanadgol

2012

Nephro Urol Mon

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BackgroundHepatitis B virus (HBV) infection is much more common in hemodialysis patients than the general population. These patients have an impaired immune response to HBV vaccination; to that end there are certain studies that have evaluated levamisole as an immunomodulator agent improving HBV vaccination response rate in hemodialysis patients.ObjectivesIn the current review, we have assembled all of the results to determine whether lavamisole is of value as an adjuvant to HBV vaccination in hemodialysis patients.Materials and MethodsScience Direct (Elsevier), ProQuest, Springer, MD Consult, BMJ Journals, Pubmed and Wiley were searched for levamisole application to HBV vaccination in hemodialysis patients. All studies revealed a seroconversion response level between levamisole plus HBV vaccine versus HBV vaccine alone.ResultsFrom 10 relevant studies, 5 studies fulfilled our inclusion criteria. Three of them suggested the significant benefit of adding levamisole to the HBV vaccine to increase augment seroprotection level in hemodialysis patients. Another study reported a decrease in seroprotection level and another study showed no significant difference caused by levamisole administration.ConclusionsDue to the limited number of studies evaluated, it is challenging to perform a definite decision about routinely administering levamisole in addition to the HBV vaccine for all hemodialysis patients. However, it does seem reasonable to recommend administration of levamisole for impaired immune response patients.

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“…Although there are studies that showed no enhancing effect of levamisole on haemodialysis patients' response rates to HBV vaccination, most studies demonstrate that levamisole has a beneficial effect . In two recent meta‐analyses by Fabrizi et al .…”

Section: Discussionmentioning

confidence: 99%

Effect of levamisole supplementation on tetanus vaccination response rates in haemodialysis patients: A randomized double‐blind placebo‐controlled trial

et al. 2013

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Levamisole as an immunomodulator drug has been demonstrated to improve the immune response to hepatitis B virus vaccination in haemodialysis patients. The aim of this randomized double-blind placebo-controlled trial was to evaluate the effect of levamisole supplementation on tetanus-diphtheria (Td) vaccine response rates in haemodialysis patients. Forty haemodialysis patients who had not received tetanus vaccination in a year before investigation and had unprotective anti-tetanus immunoglobulin G (IgG) levels (<0.1 international unit/mL) were enrolled and randomized into two equal groups to receive one dose of intramuscular Td vaccine supplemented with either levamisole (100 mg) or placebo daily, for 6 days before and 6 days after vaccination. The anti-tetanus IgG levels were measured 1 and 6 months after vaccination. One month post-vaccination, four patients were excluded from the levamisole group and two from the placebo group because of either death or renal transplantation. At 1 month, 13 out of 16 (81%) patients in the levamisole group as compared with six out of 18 (33%) patients in the placebo group developed protective anti-tetanus IgG levels (relative risk = 2.44, 95% confidence interval (CI) = 1.21, 4.88). From 1 to 6 months post-vaccination, one more patient in the levamisole group and two more patients in the placebo group were excluded because of renal transplantation. At 6 months, 11 out of 15 (73%) patients in the levamisole group as compared with four out of 16 (25%) patients in the placebo group still had protective anti-tetanus IgG levels (relative risk = 2.93, 95% CI = 1.19, 7.23). Supplementation of Td vaccination with levamisole may enhance seroconversion against tetanus in haemodialysis patients.

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Effect of Oral Levamisole Supplementation to Hepatitis B Vaccination on the Rate of Immune Response in Chronic Hemodialysis Patients

Cited by 21 publications

References 8 publications

Dendritic Cell Dysfunction in Patients with End-stage Renal Disease

Dendritic Cell Dysfunction in Patients with End-stage Renal Disease

Levamisole Usage as an Adjuvant to Hepatitis B Vaccine in Hemodialysis Patients, Yes or No?

Effect of levamisole supplementation on tetanus vaccination response rates in haemodialysis patients: A randomized double‐blind placebo‐controlled trial

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