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P233. Comparative study to evaluate the effectiveness of two different vaccination protocols against hepatitis B virus (HBV) in inflammatory bowel disease (IBD) patients

M. Chaparro1, A. Rodríguez-Nogueiras1, L.A. Menchen2, I. Marín2, V. García-Sánchez3, J. Villagrasa1, J.P. Gisbert1

1Hospital de la Princesa, Madrid, Spain; 2Hospital Gregorio Marañón, Madrid, Spain; 3Hospital Reina Sofía, Córdoba, Spain

Background: IBD patients are at higher risk of suffering severe acute hepatitis induced by HBV due to frequent use of immunosuppressive treatment. Knowing the patient's serologic condition against HBV and vaccination of negative cases is strongly recommended. However, the response rate to vaccination in these patients is low. To increase success rates, different vaccination protocols have been proposed although no study has been able to establish the optimal strategy for IBD patients.

Objectives: To evaluate the response rate to HBV vaccination in IBD patients. To compare success rates for HBV vaccination in IBD patients between two vaccination protocols. To identify predictive factors of response to HBV vaccine.

Methods: Patients diagnosed with IBD from three terciary hospitals were prospectively included. Patients were vaccinated against HBV with two different protocols: the classic protocol (Engerix B® simple dose at 0, 1 and 6 months) in two hospitals, and the new protocol with a quick schedule and double dose (Engerix B® double dose at 0, 1 and 2 months). Anti-HBs titers were measured two months after the last vaccine dose administration. The response rate to the vaccine was analyzed considering two different anti-HBs titers as cut-off points: anti-HBs >10 UI/l and >100 UI/l. A multivariate analysis was performed to identify predictive factors of response failure to the vaccine.

Results:148 patients were included (median age 38 years, 56% males, 69% Crohn's disease). 17% of patients were under immunosuppressives (22% thiopurines, 23% anti-TNF and 25% both). 60% of patients had anti-HBs >10 UI/l and 41% >100 UI/l after vaccination. 46% of patients were vaccinated with the classic protocol and 54% with the quick and double dosage schedule. The mean age and the distribution by gender, IBD type and thiopurine treatment was similar in both groups. However, the following variables were more prevalent in the group vaccinated with the classic protocol: any immunosuppressant (94% vs. 51%, p < 0.001), anti-TNF (87% vs. 16%, p < 0.001) and concommitant therapy with thiopurines and anti-TNF (48.5% vs. 5.6%, p10 UI/l as successful response to vaccination, the response rate was lower among patients under any immunossuppresive therapy (52% vs. 77%, p = 0.006) and among patients vaccinated with the classic protocol (41% vs. 75%, p < 0.001). In the multivariate analysis, vaccination with the quick doble dosage schedule was the only factor associated with a higher response to the vaccine (OR = 4, 95%CI = 2–8, p < 0.001).

Conclusions: (1) The response rate to the HBV vaccination in IBD patients is low (60%, considering successful response anti-HBs >10 UI/l). (2) The administration of double dose of vaccine (at 0, 1 and 2 months) was associated with a higher response rate to the HBV vaccine. Therefore, the double dose vaccination might be recommended for IBD patients.