P322. Hepatitis B vaccination in patients with inflammatory bowel disease: Predictors of serological response
L. Sempere1, I. Almenta1, J. Barrenengoa2, A. Gutierrez1, C. Villanueva2, E. de-Madaria1, M. Perez-Mateo1, J. Sanchez-Paya2
1Hospital General Universitario de Alicante, Gastroenterology, Alicante, Spain; 2Hospital General Universitario de Alicante, Preventive Medicine, Alicante, Spain
Background: Hepatitis B (HB) vaccination is recommended in seronegative patients with inflammatory bowel disease (IBD). IBD patients have lower response rates after HB vaccination than healthy adults. Currently only age and use of anti-TNFα drugs have been described to be associated with poor serological response. We conducted a study to assess which clinical and laboratory variables were associated with serological response to HB vaccination.
Methods: We conducted an observational retrospective study with prospective follow up. We reviewed clinical records of patients with IBD who received HBV vaccination at our center. The patients were vaccinated against HB with one dose of 20 mcgr of HBsAg given at 0, 1, and 6 months. An adequate serological response was defined as anti-HBs levels higher than 10 mUI/ml. We evaluated multiple clinical and laboratory variables: sex, age, type of IBD, Montreal classification for IBD, time evolution of IBD, perianal disease, clinical activity of IBD, previous bowel resection, extraintestinal manifestations, comorbidity, low weight, CRP levels, transferrin, albumin, concomitant treatment during the first and the third dose of vaccine and changes in therapy of IBD during the vaccination program.
Results: 123 patients started the HB vaccination program, but only 105 patients concluded it (58 male/47 female; 80 with Crohn's disease and 25 with ulcerative colitis). The mean age was 41.02±11.12 years. 50 (47.6%) patients had adequate serological response. By univariate analysis the predictive factors associated with inadequate serological response were: low levels of albumin (3.83±0.44 g/dL/4.02±0.4 g/dL), concomitant treatment with steroid during the first dose of vaccine [17 (34.7%)/33 (58.9%)] and long standing IBD (120.2±89.6 months/83±75.3 months). In Crohn's disease patients, the ileal localization also was associated with inadequate response vaccine [5 (20.8%)/33 (58.9%)]. The multivariate analysis confirmed concomitant treatment with steroid during the first dose of vaccine (OR: 0.344 [0.135–0.872]; p: 0.025) and long standing IBD (OR:0.993 [0.988–0.998]; p: 0.008) as independent predictors of inadequate serological response in IBD patients.
Conclusions: IBD patients with long standing disease or/and concomitant treatment with steroid during the first dose of vaccine have a low probability of adequate serological response after classical HBV vaccination schedule. Changes of concomitant treatment for IBD during HB vaccination program do not improve the serological response.