- Infliximab (Remicade)-treated patients with IBD showed significantly reduced response to HBV vaccination in this retrospective study.
- Vaccination might be warranted before starting infliximab, and possibly other immunomodulators.
Why this matters
- Case reports exist of patients with IBD receiving infliximab developing HBV despite vaccination.
- Not enough is known about anti-TNF and immunosuppressive medication effects on seroprotection.
- HBV surface antibody (HBsAb) was ≥10 in 55% of participants.
- Older age correlated strongly with HBsAb
- Univariate analysis, likelihood of HBsAb ≥10 IU/L:
- Anti-TNFs vs no anti-TNFs, adjusted for age and time after vaccination: OR, 0.37; P<.01.>
- Dual immunomodulator/anti-TNF therapy vs no dual therapy: aOR, 0.31; P<.001.>
- Infliximab vs no infliximab: aOR, 0.29; P<.01.>
- Infliximab: aOR, 0.30; P<.001.>
- Lower risk not seen with adalimumab (Humira).
- Single-center retrospective cohort study of adults with IBD, previous HBV vaccine or antibodies, and 6 months of immunosuppressive therapy before HBsAb titer measurement (n=391).
- Outcome: seroprotective HBsAb titer after 6 months of therapy, analyzed by individual medications and medication class.
- Funding: Individual gifts.
- Number of vaccinations not considered; some inferred from antibodies.
- Antibody titer measured once.
- Study cannot show causality.