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Kinetics of Anti–Hepatitis B Surface Antigen Titers After Hepatitis B Vaccination in Patients With Inflammatory Bowel Disease

Gisbert, Javier P. MD, PhD*,†; Villagrasa, Jose Ramón MD; Rodríguez-Nogueiras, Amelia (Nurse)*,†; Chaparro, María MD, PhD*,†

doi: 10.1097/MIB.0b013e31827febe9
Original Clinical Articles

Background: Clinically significant hepatitis B (HB) virus infection has been documented among immunocompromised patients who do not maintain anti–hepatitis surface antigen (anti-HBs) concentrations ≥10 IU/L after an adequate response to the vaccine. The aims of the study were to understand the kinetics of anti-HBs titers over time in patients with inflammatory bowel disease (IBD) who initially responded to vaccination and to identify factors predictive of losing protective anti-HBs titers.

Methods: Patients with IBD with a response (anti-HBs > 10 IU/L at 1–3 months) to HB virus vaccination were prospectively included. Anti-HBs titers were measured at 6 and 12 months. Anti-HBs titers were considered negative if they were <10 IU/L at any time during the follow-up. The kinetics of anti-HBs titers in the long term was estimated using Kaplan–Meier curves. Cox regression analysis was performed to identify the factors predictive of losing protective anti-HBs titers.

Results: The sample comprised 100 patients (mean age, 42 years; 68% Crohn’s disease; 49% on thiopurines; and 14% on anti–tumor necrosis factors during follow-up). The cumulative incidence of loss of anti-HBs titers was 2% after 6 months and 15% after 12 months. The incidence rate of loss of protective anti-HBs titers was 18% per patient-year. Baseline (after vaccination) anti-HBs titers were lower among patients whose titers became negative during the follow-up than among those who maintained them >10 IU/L (191 versus 515 IU/L; P < 0.001). Treatment with anti-TNFs was the only factor associated with a higher risk of loss of anti-HBs (hazard ratio = 3.1; 95% confidence interval = 1.1–8.8; P = 0.03).

Conclusions: A high proportion of patients with IBD with protective anti-HBs titers after vaccination lose them over time (18% per patient-year of follow-up). The risk of losing protective anti-HBs titers is 3-fold higher among patients on anti- tumor necrosis factors therapy.

Article first published online 1 February 2013

*Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain

Department of Preventive Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain.

Reprints: Javier P. Gisbert, MD, PhD, Playa de Mojácar 29. Urb. Bonanza, 28669 Boadilla del Monte, Madrid, Spain (e-mail: gisbert@meditex.es).

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas is funded by the Instituto de Salud Carlos III.

The authors have no conflicts of interest to disclose.

Received May 26, 2012

Accepted June 04, 2012

© Crohn's & Colitis Foundation of America, Inc.
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