Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Antibody Response to the Standard Hepatitis B Vaccination in Patients with Rheumatoid Arthritis and Ankylosign Spondylitis Treated with Infliximab.
Alvarez Sr.1, María Montoro, Fernandez Sr.2, Carlos Gonzalez, Exposito Sr.2, Ainhoa Gonzalez
Measurement of antibody response to standar hepatitis B vaccination in patients with infliximab. Patients treated with infliximab are at an increased risk of infections, including many that are vaccine-preventable. Risk increases with the use of immunosuppressive medications, including corticosteroids and immunomodulators. It is important to assess vaccination status early on in the clinical care of patients who will have a possibility to receive infliximab as the best chance for administering all the indicated vaccines, and having the best chance of antibody response, is prior to the initiation of immunosuppressive medications. The viral hepatitis vaccines, hepatitis A and hepatitis B, are indicated in patients under infliximab therapy. There have been reports of HBV reactivation, and acute liver failure, in at-risk patients who receive anti-TNF therapy. Anti-TNF therapy are able to decrease immunogenic response to hepatitis B vaccine.
All rheumatoid arthritis (RA) and ankylosis spondylitis (Asp) patients receiving infliximab theraphy (> 6 months), at rheumatology day care unit, with antiHBs negative were advice to received standar vaccination. Standar vaccination is given by receiving 3 intramuscular injections of the standard dose (20 mg) of recombinant HBV vaccine at weeks 0, 4, and 24. Percentage of responders at week 28, defined as patients with hepatitis B surface antibody (anti-HBs) of more than 10 mIU/mL who received at least 2 dose of vaccine. Patients with missing anti-HBs titer measurement at the final follow-up visit at week 28 were considered to be nonresponders. Post-vaccination titers should be obtained to confirm antibody response.
Complete vaccination was administered in 52 patients (27 ASp, 25 RA). Titer of antiHBs >10 was achieved for 1 patient with RA and 3 patients with Asp. Nonresponders were 89% (24/27) in SpA and 96% (24/25) in RA. No serious adverse event possibly related to vaccine were reported.We observe in our patients on infliximab TNF treatment a decreased antibody response to HBV vaccination. It was measured by titers of anti-HBs antibody 28 week after first dosage of vaccine.
Antibody titer that define protection is not well know. Addressing HBV status, and vaccinating at-risk patients, should be a priority in patients who may require anti-TNF therapy. It is important to educate both physicians and patients regarding vaccination recommendations. Addressing these issues early on, gives more options in terms of ensuring optimal antibody response to the vaccination. Alternative schedules more immunogenic than the standard hepatitis B vaccine regimen are needed in patients under infliximab therapy
To cite this abstract, please use the following information:
Alvarez Sr., María Montoro, Fernandez Sr., Carlos Gonzalez, Exposito Sr., Ainhoa Gonzalez; Antibody Response to the Standard Hepatitis B Vaccination in Patients with Rheumatoid Arthritis and Ankylosign Spondylitis Treated with Infliximab. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1316