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P300. Vaccination routines during anti-TNF treatment in IBD: Do patients adhere to ECCO's guidelines?

K. Risager Christensen, C. Steenholdt, S. Schnoor Buhl, M.A. Ainsworth, O.Ø. Thomsen, J. Brynskov, Herlev University Hospital, Department of Gastroenterology, Herlev, Denmark

Background

TNF-inhibitors used to treat inflammatory bowel disease (IBD) may result in severe infections due to the generalized immunosuppression. Accordingly, international guidelines now recommend that all patients are screened for latent infections prior to initiation of anti-TNF therapy; and receive vaccination against common infectious agents. However, clinical experience indicates that vaccination guidelines are challenging to implement in practice. We investigated if patients actually receive adequate information about vaccinations in a routine clinical setting; and if relevant information increases adherence to vaccination guidelines. Furthermore, we identified main reasons for non-adherence.

Methods

Observational, cross-sectional cohort study of IBD patients in ongoing anti-TNF therapy per March 2013 at a tertiary Danish IBD center. Vaccination details were obtained by questionnaire. European Crohn and Colitis Organisation (ECCO) guidelines served as gold standard [1].

Results

130 (83%) (n = 90 Crohn's disease, n = 40 ulcerative colitis) of 157 patients responded. Sixty-four percent of responders received infliximab and 36% received adalimumab. Sixty-two patients (48%) reported to have received information from a health care professional about vaccination recommendations before initiation or during ongoing anti-TNF therapy. Information about vaccination guidelines increased patients' adherence hereto. Hence, the percentage of patients who had hepatitis B vaccination increased from 24% before information to 52% after information was given (P < 0.001), pneumococcal vaccination increased from 7% to 24% (P < 0.001), human papilloma virus vaccination from 19% to 32% (P < 0.01), and annual influenza vaccination from 26% to 58% (P < 0.001). Information increased overall adherence to ECCO's vaccination guidelines: the proportion of non-compliant patients decreased from 43% to 10% after information; partial compliance increased from 56% to 81%; and full compliance increased from 0% to 10%. Main barriers for patients' adherence to vaccination guidelines were forgetfulness (36%), financial reasons (32%), skepticism (14%), and worries (7%).

Conclusion

Focused information from health care professionals about recommended vaccinations during anti-TNF therapy in IBD significantly increased patients' adherence. However, only a minority completely adhered to ECCO's vaccination guidelines. Notable barriers were forgetfulness and financial reasons. Proposed strategies for improved adherence include education of health care professionals, repeated information to patients, and preferably financial support.

1. Rahier JF et al. J Crohns Colitis 2009; 3: 47–91.