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J Crohns Colitis. 2014 Nov;8(11):1529-38. doi: 10.1016/j.crohns.2014.06.009. Epub 2014 Jul 19.

Impact of surveillance of hepatitis b and hepatitis c in patients with inflammatory bowel disease under anti-TNF therapies: multicenter prospective observational study (REPENTINA 3).

Author information

1
Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
2
Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
3
Department of Gastroenterology, Hospital de Cabueñes, Gijón, Asturias, Spain.
4
Department of Gastroenterology, Consorci Sanitari de Terrassa, Catalonia, Spain.
5
Department of Gastroenterology, Hospital Universitari la Fe, Valencia, Spain.
6
Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
7
Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
8
Department of Gastroenterology, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí de Sabadell, Catalonia, Spain.
9
Department of Gastroenterology, Hospital Santiago de Compostela, Santiago de Compostela, Galicia, Spain.
10
Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Electronic address: mestevecomas@telefonica.net.

Abstract

AIMS:

Assess IBD patients starting anti-TNF for the impact of preventive measures in HBV and/or HCV, and the predictive response factors to HBV vaccination.

METHODS:

Multicenter prospective study including 389 IBD patients. Four interventions were established: I-1) anti-HBs <100IU/L: HBV vaccination with double doses at 0-1-2months, and revaccination if titres <100IU/L (seroprotection defined as anti-HBs10-100IU/L and effective vaccination anti-HBs >100IU/L); I-2) anti-HBs >100IU/L (previous effective vaccination): monitoring levels; I-3) anti-HBc and/or HCV+: analysis every two months; I-4) HBsAg+: start anti-virals.

RESULTS:

I-1 and I-2) For first vaccination, effective vaccination and seroprotection were obtained in 26.4% and 43.5%, and for revaccination 31.3% and 44.4%, respectively. Predictive factors of effective vaccination were age ≤30years (OR=2.2) and being vaccinated simultaneously with anti-TNF (OR=5.2) instead of late vaccination, whereas age ≤30years (OR=2.6) and anti-TNF monotherapy (OR=2.4) were predictive for seroprotection. 80.8% of patients previously vaccinated maintained titres at 29months follow-up. The only factor related to maintaining titres was previous vaccination versus achieving effective vaccination during anti-TNF (HR=2.49); I-3 and I-4) HBV-DNA + without reactivation was detected in 7% of 29 anti-HBc. No reactivation was found in the remaining HCV (n=5) or HBsAg (n=4) patients.

CONCLUSIONS:

1) Response to vaccination/revaccination is low in patients with anti-TNF. Young patients vaccinated at the beginning of anti-TNF and receiving it as a monotheraphy showed better response. 2) Long-lasting effective vaccination is greatest in patients previously vaccinated. 3) Following-up the established surveillance and/or preventive anti-viral therapy seems to be safe in HBV and HCV patients.

KEYWORDS:

Anti-TNF treatment; Hepatitis B; Hepatitis B vaccination; Hepatitis C; Inflammatory bowel disease

PMID:
25052345
DOI:
10.1016/j.crohns.2014.06.009
[Indexed for MEDLINE]

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