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HBV vaccine less effective in RA patients
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People treated for rheumatoid arthritis had less protection from hepatitis B virus infection even after receiving the vaccine compared with the general population, according to new data presented at the European League Against Rheumatism Annual European Congress of Rheumatology.
“The majority of [rheumatoid arthritis (RA)] patients tested as part of our study were not protected by hepatitis B vaccination,” Misha Tilanus, medical student at Radboud University Medical Centre, Nijmegen, Netherlands, said in a press release. “People with [rheumatoid arthritis] have an increased risk of morbidity and mortality from infections, and to discover that immunization might not confer protection is a real concern. It’s crucial that patients and health care practitioners are aware of this lack of efficacy and do all they can to minimize risk.”
Tilanus and colleagues, including Jakob Fransen, PhD, of Radboud University Medical Centre, assigned 47 patients with RA 10 µg/L of the HBV vaccination HBVAXPRO and compared the efficacy with that of 156 similarly dosed health care workers. Each patient completed the standard vaccine schedule with doses at 0, 1 and 6 months, and they were followed through 28 weeks. Vaccine response was determined if patients had titers of more than 10 IU/L and confirmed to be protected from HBV, according to the researchers.
Overall, control patients had a higher response rate to the vaccine compared with RA patients (83% vs. 11%; P < .001). Among RA patients, 42 were nonresponders, four were low responders, and one was a high responder. There were 27 nonresponders, 31 low responders and 98 high responders in the control group.
RA patients had a greater risk for nonresponse compared with controls (adjusted OR = 44; 95% CI, 14-148) after factoring in age and gender.
There were no differences in response between RA patients using disease-modifying antirheumatic drugs (DMARDs) vs. anti-TNF agents or therapy with rituximab vs. anti-TNFs.
“Based on this study, hepatitis B vaccination is less effective in RA patients using biologicals and/or DMARDs than in the general population,” the researchers concluded.
Reference:
Tilanus M, et al. Abstract #OP0167. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology; June 10-13, 2015; Rome.
Disclosure: The researchers report no relevant financial disclosures.