P502. Effect of immunosuppressive treatment in the efficacy of Hepatitis B vaccine in patients with inflammatory bowel disease
J. Santos-Antunes, P. Andrade, S. Rodrigues, F. Magro, S. Lopes, G. Macedo, Centro Hospitalar São João, Gastroenterology, Porto, Portugal
Aim: To assess the timing of Hepatitis B vaccination in our institution and to study its efficacy, measured by the production of anti-HBs antibodies, in a cohort of patients with IBD under infliximab and/or azathioprine. Vaccination was considered efficient when anti-HBs antibody levels exceeded 10 UI/L.
Results: We identified 217 patients with IBD under infliximab who were vaccinated for Hepatitis B, 172 (79%) with Crohn's Disease and the remaining with Ulcerative Colitis; 114 patients (53%) were male and mean age was 33±11 years. Overall, HBV vaccine was successful in 164 (76%) patients; 43% had antibodies titers above 100 UI/L. Only 14 patients were vaccinated after infliximab and, of them, only 2 had antibodies above 10 UI/L. In contrast, vaccination was efficient in 82% of the patients vaccinated before infliximab (p < 0.001). Median levels of anti-HBs antibodies in patients vaccinated after and before infliximab were 1 UI/L (Interquartile Range (IQR) 0–3 UI/L) and 84 UI/L (IQR 15–395 UI/L) respectively (p < 0.001). Among the patients vaccinated before the beginning of infliximab, 88% of those vaccinated before azathioprine developed antibodies, in contrast to 55% who were under azathioprine; this difference was significant even in multivariate analysis (p = 0.03). Mean age was similar in those who did or did not respond to the vaccine (p = 0.141).
Conclusions: Our Hepatitis B vaccination policy in this population is very successful, since the vast majority is being vaccinated before starting infliximab, therefore achieving good response rates. This is of major importance, as observed in the poor immunization capability of the vaccine in those already under anti-TNF. In contrast to previous reports, our data suggests that azathioprine can also influence negatively the immune response to HBV vaccine.
Effectiveness of infliximab as remission-induction therapy in patients with active ulcerative colitisK. Kawagishi, S. Ooka, M. Mukae, M. Sada, K. Kobayashi, W. Koizumi, Kitasato University School of Medicine, Gastroenterology, Sagamihara, Japan
Background and Objectives: In Japan, about 3 years have elapsed since infliximab (IFX) was approved for the treatment of ulcerative colitis (UC). However, many factors, such as the optimal timing of treatment and the positioning of IFX among other drugs, remain unclear. We retrospectively studied the effectiveness of remission-induction therapy with IFX.tgP>Subjects: The study group comprised 28 patients who received induction therapy with IFX in our hospital.
Partial Mayo scores (pMS; maximum, 9 points) were used to evaluate treatment effectiveness for clinical symptoms. Remission was defined as a pMS of ≤2 plus a rectal bleeding score of 0 or 1. Improvement was defined as a pMS of ≥2 with a ≥30% decrease plus a rectal bleeding score of 0 or 1. No change was defined as the same pMS or a decrease of ≤1. Exacerbation was defined as a pMS higher that before treatment.
Variables: The following variables were assessed: (1) treatment outcomes in all patients who received IFX; (2) a comparison of treatment effectiveness among steroid-dependent patients (n = 14), steroid-resistant patients (n = 5), and steroid non-users (n = 9); and (3) adverse reactions.
Outcomes: (1) The pMS in the study group as a whole was 6.5 at the start of treatment, 3.6 at week 2, 1.8 at week 8, and 1.3 at week 14. The remission/response rate was 65% at week 2, 72% at week 8, and 88% at week 14. (2) The pMS at the start of treatment with IFX was 5.7 in steroid-dependent patients, 7.7 in steroid-resistant patients, and 7.2 in steroid non-users, with no significant differences. The pMS at week 14 had decreased to 2.3 in steroid-dependent patients, 0 in steroid-resistant patients, and 0.4 in steroid non-users (p < 0.01). (3) The remission/response rate 2 weeks after treatment with IFX was 46% in steroid-dependent patients, 100% in steroid-resistant patients, and 75% in steroid non-users, indicating that steroid-resistant patients and steroid non-users promptly responded to treatment. At 14 weeks the remission/response rate was 77% in steroid-dependent patients, 100% in steroid-resistant patients and 88% in steroid non-users. (4) Surgery was performed in 3 patients. The reason for surgery was no change in symptoms in the steroid-dependent patients and massive bleeding in the steroid-resistant patient. (5) Adverse reactions occurred in 12 patients (42%). Serious adverse included Pneumocystis carinii pneumonia in 1 patient, sepsis in 4, and lupus syndrome in 3.
The remission-induction rate was about 72% at week 14 of treatment with IFX in patients with active UC. IFX therapy was effective even in steroid non-users and should therefore be considered as a treatment option for UC in the future.