Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Immunogenicity of pneumococcal and influenza vaccine in patients with rheumatoid arthritis (RA) have been assessed in many studies. However, the humoral immune response of hepatitis B vaccination in RA patients is not clearly known. This study aims to assess the humoral immune response of hepatitis B vaccination in RA patients receiving conventional synthetic and biological disease modifying anti-rheumatic drugs (csDMARDs and bDMARDs).
Methods:
Forty-five patients with RA (study group), 33 patients received only csDMARDs and 12 patients received both csDMARDs and bDMARDs, and 9 healthy age- and sex-matched subjects (control group) were enrolled in this prospective open-label single-center study. All patients had negative results for hepatitis B surface antigen, hepatitis B core antibody, and hepatitis B surface antibody (anti-HBs) on screening. All subjects received 20 μg of recombinant hepatitis B vaccine (Euvax B®) at weeks 0, 4, and 24. Blood samples were collected 8 weeks after receipt of the third vaccine dose to test for anti-HBs. The responder and high responder were defined as anti-HBs levels of ≥ 10 mIU/ml and ≥ 100 mIU/ml, respectively. Treatment related adverse events reported by patients or observed by physician were collected at every visit. The study was approved by the ethic committee and institutional review board.
Results:
Eight weeks after vaccination, the number of responder significantly lower in study group than control group (64% vs 100%, p = 0.04) (Table). In the study group, older age and rituximab use were significantly associated with hepatitis B vaccine non-response (p = 0.04 and p = 0.02, respectively), while disease duration, disease activity, comorbidities, and the use of prednisolone, methotrexate, etanercept, or infliximab were not associated with hepatitis B vaccine non-response. In subgroup analyses, RA patients receiving csDMARDs tended to has lower number of responder compared with control group (70% vs 100%, p = 0.09). However, the number of high responder was significantly lower in patients receiving csDMARDs compared with control group (52% vs 100%, p = 0.01). In RA patients receiving bDMARDs, the number of responder and high responder were significantly lower compared with control group (50% vs 100%, p = 0.02, 42% vs 100%, p = 0.01). No serious adverse event was observed, but one patient (2%) experienced flare of arthritis.
Conclusion:
In RA patients receiving csDMARDs and bDMARDs, older age and rituximab use associated with impaired humoral immune response to hepatitis B vaccine. Further studies are required to confirm these findings in larger numbers of subjects.
|
Healthy subjects (n = 9) |
All RA patients (n = 45) |
RA receiving csDMARDs (n = 33) |
RA receiving bDMARDs (n = 12) |
|
|
Responder (anti-HBs ≥ 10 mIU/ml), % |
100% |
64% (p = 0.04) |
70% (p = 0.09) |
50% (p = 0.02) |
|
High responder (anti-HBs ≥ 100 mIU/ml), % |
100% |
49% (p = 0.01) |
52% (p = 0.01) |
42% (p = 0.01) |
To cite this abstract in AMA style:
Intongkam S, Pakchotanon R, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of Conventional Synthetic and Biological Disease Modifying Anti-Rheumatic Drugs on the Immunogenicity of Hepatitis B Vaccine in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/effect-of-conventional-synthetic-and-biological-disease-modifying-anti-rheumatic-drugs-on-the-immunogenicity-of-hepatitis-b-vaccine-in-patients-with-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-conventional-synthetic-and-biological-disease-modifying-anti-rheumatic-drugs-on-the-immunogenicity-of-hepatitis-b-vaccine-in-patients-with-rheumatoid-arthritis/