Infliximab might impair hepatitis B vaccine response

  • Inflamm Bowel Dis

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.>
  • Multivariate analysis, likelihood of HBsAb ≥10 IU/L:
    • Infliximab: aOR, 0.30; P<.001.>
    • Lower risk not seen with adalimumab (Humira).

Study design

  • 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.

Limitations

  • Number of vaccinations not considered; some inferred from antibodies.
  • Antibody titer measured once.
  • Study cannot show causality.