Primary seroresponses to double-dose compared with standard-dose hepatitis B vaccination in patients with chronic kidney disease: a systematic review and meta-analysis

Mulley, William R.; Le, Suong; Ives, Kathryn

doi:10.1093/ndt/gfv443

Cited by 26 publications

(23 citation statements)

References 20 publications

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“…Thereby, 30-70% of dialysis patients do not respond to their first hepatitis B vaccination [12,13] and 50-70% to a second vaccination, while the response rate in the general population is about 90% [14]. The antibody titre is also lower in dialysis patients with a per-centage of seroprotection of about 30% in a recent metaanalysis [15], and the duration of seroprotection is shorter. Hence, achieving proper and durable HBV vaccine response is still an unmet medical need in dialysis patients, and defining strategies to improve vaccine response is necessary.…”

Section: Discussionmentioning

confidence: 98%

No Improvement of Hepatitis B Vaccination Response in Patients Dialysed with a Polymethylmethacrylate Membrane Compared to High-Flux Polysulfone: Results of the HEPADIAL Study

Précigout¹,

Germain²,

Bénard³

et al. 2019

Blood Purif

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Background: An altered immune response and decreased vaccine response are observed in patients with chronic renal failure. A preliminary study of 15 non-immunised patients, despite appropriate previous hepatitis B vaccination, showed a 60% seroconversion rate after 3 months of dialysis with a polymethylmethacrylate (PMMA) membrane. This response was associated with circulating soluble CD40 (CD40s) decrease, a natural inhibitor of the humoral immune response. The aim of the study is to confirm these results in a randomised study. Methods: We conducted a multicentre randomised intention-to-treat superiority clinical trial comparing polysulfone and a PMMA membrane in 2 parallel patient de Précigout et al.(281-512) pg/mL (p = 0.08). Conclusion: We did not observe a better vaccine response with the PMMA membrane compared to high-flux polysulfone. The PMMA membrane did not decrease the CD40s more than the polysulfone membrane probably because the titre was previously low in the 2 groups.

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Section: Discussionmentioning

confidence: 98%

No Improvement of Hepatitis B Vaccination Response in Patients Dialysed with a Polymethylmethacrylate Membrane Compared to High-Flux Polysulfone: Results of the HEPADIAL Study

Précigout¹,

Germain²,

Bénard³

et al. 2019

Blood Purif

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“…37 However, a concern is that seroprotection rates in these SOT candidates are still suboptimal even with the double-dose (40 µg) hepatitis B immunization schedule. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] The expectation of low effectiveness of currently licensed HBV vaccines in renal transplant recipients was shown to be the most important barrier to guideline adherence among Dutch nephrologists. 38 Similarly for liver transplant candidates, HBV immunity rate was significantly lower in patients with more advanced liver dis- should be immunized with the hepatitis B vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…14,20,23,24 A recent systematic review also reported a poorer immune response in patients with end-stage renal disease with 24%-42% seroprotection after standard-dose (20 µg) HBV vaccination and 51%-69% after double-dose (40 µg) vaccination. 25 Low success rates of HBV vaccination have also been reported in cardiac and pulmonary transplant candidates. 26,27 Recent data on the immunization rate among SOT candidates in a low HBV endemic region and the effect of universal infant vaccination have not been explored thus far.…”

Section: Introductionmentioning

confidence: 99%

The effect of universal infant vaccination on the prevalence of hepatitis B immunity in adult solid organ transplant candidates

Koc

Dupont

Vos

et al. 2020

Journal of Viral Hepatitis

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Background Hepatitis B virus (HBV) immunity is recommended to optimize outcomes after solid organ transplantation (SOT). This study assessed the prevalence and predictors of HBV immunity at the time patients were placed on transplant waiting list over a period from 1997 to 2019 in a low HBV endemic region. Methods Data were obtained from the University Hospitals Leuven transplant database. Minors and patients with past/current HBV infection were excluded. From 1986, Belgian patients are covered by the universal infant vaccination; therefore, birth cohort was stratified in those born ≥1986 vs <1986. Results The study population consisted of 3297 SOT candidates. HBV immunity rate was superior in renal transplant candidates (55.3%), and this number was 21.5%, 15.4% and 16.8% for liver, cardiac and pulmonary transplant candidates, respectively, P < .001. Among liver transplant candidates, HBV immunity rate was 14.8% in decompensated cirrhotic patients and 27.9% in those without advanced cirrhosis (P < .001). The overall immunity rate increased from 19.3% in period 1997‐2008 to 32.8% in 2009‐2019, P < .001. In multivariable analyses, younger age (odds ratio (OR) 95% confidence interval (CI): 0.97‐0.98, P < .001) and birth cohort ≥ 1986 (OR 95% CI: 1.18‐2.66, P = .006) were associated with increased HBV immunity. Conclusion An increase in HBV immunity was observed over a 20‐year period related to the introduction of universal infant HBV vaccination. Nevertheless, this study highlights the low overall HBV immunity at the time of listing for organ transplantation and points out the need of an increased awareness and vaccination strategy at an early disease stage.

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“…The vaccine schedule recommended for pre-dialysis patients consists of 3 shots with standard doses of hepatitis B virus vaccine (20 mcg; 0,1, and 6 months) (7). A recent systematic review concluded that double-dose vaccination for CKD patients did not improve seroconversion compared to patients on standard HBV vaccine; the lower number of studies could be implicated in these conflicting findings (41).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Reinforced Versus Standard Vaccine Schedule Towards Hepatitis B In Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Fabrizi

Donato

2017

Hepat Mon

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Context: The immunogenicity of the hepatitis B virus vaccine is reduced in patients with renal failure compared with the nonuraemic population. A variety of approaches have been suggested to improve the immune response in uraemic population including an increase in dose of the hepatitis B vaccine. Objective: To compare the efficacy and safety of hepatitis B vaccine schedules based on greater versus standard doses of HB vaccine in patients with chronic kidney disease stages 3 -5. Evidence Acquisition: We carried out a systematic review of the medical literature with a meta-analysis of randomized trials comparing seroprotection rates after greater vs. standard doses of the HB vaccine. The odds ratio to obtain seroprotection among patients who received greater (study group) vs. standard (control group) doses was the end-point of interest. We used a random-effects approach, as described by DerSimonian and Laird, with heterogeneity and subgroup analyses. Results: We retrieved 11 clinical trials (n = 870 unique patients); 2 (n = 141 patients) and 8 studies (n = 689) included CKD patients on pre-dialysis and dialysis stage, respectively. Three trials (n = 368 patients) employed plasma-derived vaccine; 8 (n = 502) adopted recombinant vaccine. Aggregation of study results (n = 10 studies) showed that the seroprotection rate (short-term follow-up) towards HB virus was higher among patients receiving greater than standard doses of vaccine [pooled OR, 2.10, 95% confidence intervals, 1.15 -3.82]. The P-value was 0.0001 for our test to study heterogeneity. The seroprotection rate towards HBV was much greater in the subset of trials (n = 2) based on plasma-derived vaccine (OR, 3.78; 95% CI, 2.35; 6.07), and no heterogeneity was found (NS). In the subset of RCTs (n = 8 studies), the seroprotection rate was higher among patients receiving greater doses of vaccine towards HBV, OR, 2.01 (95% CI, 0.92; 4.39), with significant heterogeneity (P = 0.002). Tolerance was satisfactory and no dropouts due to side effects were reported. Conclusions: Vaccine schedules based on greater than standard doses of HB vaccine offer higher immunogenicity in patients with chronic kidney disease. These results support the current recommendations to give higher doses of HBV vaccine to susceptible dialysis population in order to increase the sero-protection rate. Further research is needed to assess whether these findings apply to HB vaccines provided with novel adjuvants.

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Primary seroresponses to double-dose compared with standard-dose hepatitis B vaccination in patients with chronic kidney disease: a systematic review and meta-analysis

Cited by 26 publications

References 20 publications

No Improvement of Hepatitis B Vaccination Response in Patients Dialysed with a Polymethylmethacrylate Membrane Compared to High-Flux Polysulfone: Results of the HEPADIAL Study

No Improvement of Hepatitis B Vaccination Response in Patients Dialysed with a Polymethylmethacrylate Membrane Compared to High-Flux Polysulfone: Results of the HEPADIAL Study

The effect of universal infant vaccination on the prevalence of hepatitis B immunity in adult solid organ transplant candidates

Efficacy and Safety of Reinforced Versus Standard Vaccine Schedule Towards Hepatitis B In Chronic Kidney Disease: A Systematic Review and Meta-Analysis

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