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P438. Multicenter prospective observational study to assess the impact of surveillance, prophylaxis or treatment of the hepatitis B (HBV) and C (HCV) virus infection in patients with inflammatory bowel disease (IBD) under anti-TNF therapies

C. Loras1, J.P. Gisbert2, C. Saro3, M. Piqueras4, C. Sánchez5, J. Barrio6, I. Ordás7, A. Montserrat8, R. Ferreiro9, F. Fernández-Bañares1, M. Esteve1, 1Hospital Universitari Mútua de Terrassa, Terrassa, Spain, 2Hospital de la Pincesa, Spain, 3Hospital de Cabueñes, Spain, 4Consorci Sanitari de Terrassa, Spain, 5Hospital Universitario La Fe, Spain, 6Hospital Universitario Río Hortega, Spain, 7Hospital Clínic, Spain, 8Hospital del Parc Taulí, Spain, 9Hospital Santiago de Compostela, Spain

Background

HBV reactivation related to immunosuppressants in IBD patients may be life threatening. Active prevention and/or treatment are necessary.

Aim: To assess in IBD patients under anti-TNF: (1) predictive factors to response HBV vaccination, (2) impact of prevention or treatment of HBV and/or HCV infection.

Methods

Muticenter prospective observational study including IBD patients who started anti-TNF. Schedule (S) depending on markers: (S1) negatives: HBV vaccination with rapid double doses schedule (0–1-2 months), revaccination with same schedule if titers <100 IU/mL; (S2) anti-HBs >100 (previous vaccination): monitoring levels at 4 months of anti-TNF start (seroprotection was defined as anti-HBs >10 and effective vaccination anti-HBs >100); (S3) positive anti-HBc or HCV: monitoring blood tests every 2 months; (S4) HBsAg+: start antivirals. LRA was done to evaluate predictive factors of vaccination.

Results

389 patients were included under anti-TNF (248 IFX, 138 ADA, 3 Certo). According to schedule:

(S1) Effective vaccination and seroprotection were obtained in 26.5% (67/253) and in 43.5% (110/253), being for the revaccination 31.5% (45/143) and 44% (63/143), respectively. For the first vaccination, age ≤35 yrs (OR, 2.1) and start the vaccination simultaneously with the anti-TNF (vs late vaccination) (OR, 4.4) were the only predictive factors of effective vaccination. Age ≤35 yrs (OR, 2.8) and anti-TNF monotherapy (OR, 2.6) were predictive for seroprotection. For revaccination, age ≤40 years (OR, 4.1) and seroprotection to first vaccination (OR, 2.9) were the only predictive factors of effective vaccination.

(S2) 88% (87/99) of the patients with previous vaccination, maintain titers 4 months after start of anti-TNF. Anti-HBs titers >100 after a follow-up of 36 months, were higher in patients with previous vaccination (S2) than in those who achieved effective vaccination during anti-TNF (S1) (83% vs 36%, p < 0.001; OR, 9).

(S3–4) In 2 of 29 anti-HBc+ patients (7%), HBV-DNA+ was detected without reactivation. No reactivation was detected in the rest of HCV (n = 5) or HBsAg+ (n = 4).

Conclusion

(1) Response to vaccination and revaccination is low in patients with anti-TNF, being the young age and anti-TNF monotherapy predictors of better response. (2) Seroprotection at first vaccination is predictive of effective vaccination after revaccination. (3) Maintaining long-term effective vaccination is low when the vaccination is administered during anti-TNF. (4) Following the schedule of prevention and treatment, nor HBV nor HCV reactivation was observed in patients under anti-TNF.