Background The increasingly frequent use of biologic agents in rheumatic diseases implies the existence of a large number of patients at risk of reactivation of hepatitis B virus (HBV). Rheumatic patients are at higher risk than general population because of their underlying disease and immunosuppressive treatment. Therefore they need to be screened for HBsAg and anti-HBc before starting treatment (especially in case of biological therapies), and HBsAg seronegative patients must received vaccination.
The response to HBV vaccine could be lower in rheumatic patients although no comparative studies with the general population has been made, and biological treatment could also reduce overall vaccine response.
We report the data resulting from the vaccination program rheumatic patients in our hospital.
Objectives 1. To describe the pattern of serological markers of HBV in rheumatic patients before initiation of biologic treatment.
2. To assess immune response to hepatitis B vaccination in HBsAg seronegative patients candidates of biological treatment.
Methods Retrospective longitudinal descriptive study. Study period: 2009-2012.
Study population: patients candidates of biological treatment after failure to conventional immunosuppressants.
HBV vaccine administration pattern: conventional (20mcg) 0.1 and 6 months. Requested serological markers a month post-vaccination: HBsAb, HBsAg and HBcAb.
The vaccine regimen was initiated before the start of biological treatment, and finished once initiated.
Results Seventy eight patients with rheumatic diseases were registered. The mean age of the patients was 43.22±14.73 years, with a predominance of women (65.38%). Of these patients, 43 had indication for vaccination patients (the rest had past infection or immunization after vaccination). The average age of this group was 44.06±12.93 years, with 61.36% of women.
The disease distribution was as follows: the 30.23% (13) had rheumatoid arthritis, the 39.53% (17) spondylitis, 3 patients had juvenile idiopathic arthritis, 3 Behcet's disease, 4 LES, 2 Still's disease, 1 Wegener and another one a P -ANCA + vasculitis.
And the distribution of different treatments: the 30.23% started ETN, Infliximab the 23.25%, another 23.25% rituximab, adalimumab in 9.3%, another 9.3% tocilizumab, golimumab one patient and another one abatacept.
Of the patients who started the vaccine regimen, 28 (65.11%) completed it at the hospital, and 20 of these (71.42%) were responders.
Conclusions The vaccination program for rheumatic patients in our hospital is useful for detecting patients susceptible to viral reactivation and initiate the vaccination scheme if is necessary.
The response to the vaccine in healthy individuals is estimated around 85%, whereas in a study of patients with rheumatoid arthritis immunization against HBV was observed in 68% of patients, similar than in our study.
A high proportion of our patients do not complete the vaccination so it is necessary to promote adherence by clinicians involved in the process.
Elkayam O, Yaron M, Caspi D. Safety and efficacy of vaccination against hepatitis B in patients with rheumatoid arthritis. Ann Rheum Dis. 2002, 61:623-5.
Disclosure of Interest : None declared
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