Background In recent years the different drug treatments in rheumatic patients can lead to situations of immunosuppression associated with an increased risk of infection by immunization.
Objectives To present preliminary results of vaccination against hepatitis B with double-dose schedule and its effectiveness in these patients. following the protocol of the Hospital Universitario 12 de Octubre.
Methods Of the 532 adult patients referred by the Department of Rheumatology at the Immunization Unit of Preventive Medicine of this hospital to assess their vaccination status from the beginning of the protocol in January 2010,
177 correspond to diagnosis of RA. Of the patients diagnosed with RA 35 were not vaccinated (background infection, previously vaccinated, did not accept, etc.). Of the 142 remaining vaccine left 9 and 21 were pending completion of the vaccination schedule. Of the remaining 112, 28 are pending serological testing postvaccination. We have studied the variables of sex, treatment with corticosteroids (yes/no), and other treatments such as methotrexate, anti-TNF monotherapy, MTX and anti-TNF, corticosteroids and other DMARDs. 84 of the patients for whom vaccination was indicated (negative antibody level against HBsAg) were vaccinated with a double dose.
Results Of the patients diagnosed with RA (84), 65 patients completed vaccination with double-doses and postvaccination antibody. Of these 65 patients, 32 (50%) presented a positive control and 33 post-vaccination negative serology. Among patients with positive results, 28 were women and 4 men.
Of the patients who tested positive, 20 (62.5%) were not administered corticosteroids. 45.5% of patients with negative results were not administered corticosteroids (15/33). Of the 13 patients treated with MTX monotherapy, 11 tested positive and 2 negative in the post-vaccine control. In patients treated with anti-TNF monotherapy, only 1 woman was positive and 4 (1 man and 3 women) negative in the post-vaccine control. Of the 12 patients treated with MTX and anti-TNF post-vaccination, 9 were women 3 of whom were positive. Of the 12 patients vaccinated and control treated with corticosteroids and other DMARDs, 7 were positive.
Conclusions We present preliminary results of vaccination effectiveness against hepatitis B in patients with RA. 50% of the patients in the post-vaccination control were positive. 62.5% of the patients who tested positive are not associated with taking steroids. We understand the need to increase vaccination policies from the time of their diagnosis, before the patients begin with immunosupression treatment.
Elcayam O, Yaron M, Caspi D. Safety and efficacy of vaccination against hepatitis B in patients with rheumatoid arthritis. Ann Rheum Dis 2002; 61:623-625.
Brezinschek HP, Hofstaetter T, Leeb BF, Haindl P, Graninger W. Immunization of patients with rheumatoid arthritis with antitumor necrosis factor- therapy and methotrexate. Clinical therapeutics 2008; 20:295-299
Disclosure of Interest None Declared
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