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P231. Efficacy of hepatitis B vaccination and re-vaccination and factors impacting on the response in inflammatory bowel disease patients

J.P. Gisbert1, J.R. Villagrasa2, A. Rodríguez-Nogueiras1, M. Chaparro1

1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain; 2Hospital Universitario de La Princesa, IP, Medicina Preventiva, Madrid, Spain

Background: Vaccination against hepatitis B (HBV) is recommended in patients with inflammatory bowel disease (IBD). However, only a few studies have addressed the response to HBV vaccination in these patients.

Aims: (i) to assess the HBV vaccine efficacy in a large sample of patients with IBD; (ii) to evaluate the influence of the treatment with immunosuppressors and anti‑TNF drugs; and (iii) to assess the success rate after the re-vaccination in patients who failed to the first attempt.

Methods: Patients diagnosed with IBD were vaccinated against HBV with a quick, double dose schedule (Engerix B® double dose at 0, 1 and 2 months). Anti-HBs titers were measured two months after the last vaccine dose. A multivariate analysis was performed to identify predictive factors of response to the vaccine. In non-responders, a second vaccination was administered with the same dosage and schedule.

Results: 241 patients (mean age, 44 years; 62% Crohn's disease, and 38% ulcerative colitis) were included. 40% were on immunomodulators, and 20% on anti‑TNF therapy when the vaccination was administered. 59% of patients (95%CI = 52–65%) had anti-HBs >10 IU/l after the vaccination, while 39% (95%CI = 32–45%) had anti-HBs >100 IU/l. In the univariate analysis, the response rate (anti-HBs >10 IU/l) to the vaccine was lower among patients under anti‑TNF therapy: 46% vs. 62% (p < 0.05). In the multivariate analysis, the age and being under anti‑TNF therapy were the only factors associated with the response to the vaccine (anti-HBs >10 IU/l), with a lower response rate in older patients (OR = 0.96; 95%CI = 0.94–0.98; p < 0.001) and in those receiving anti‑TNF drugs (OR = 0.39; 95%CI = 0.2–0.76; p < 0.01). The response rate (anti-HBs >100 IU/l) after the re-vaccination in patients who had previously failed was 42% (95%CI = 29–54%). Therefore, adequate anti-HBs antibody level (anti-HBs >100 IU/l) was finally reached, overall, in 65% of the patients.

Conclusions: The response rate to the HBV vaccination, even when a double dose schedule is administered, is very low in IBD patients, mainly in those receiving anti‑TNF therapy. However, treatment with immunosuppressors does not seem to impact on the efficacy of the VHB vaccine. A considerable, although still insufficient, success rate may be obtained when two consecutive vaccination courses, with 3‑dose vaccine series each one, are administered.