Factors predicting response to hepatitis B vaccination in patients with inflammatory bowel disease.

Hepatitis-B-seronegative patients with inflammatory bowel disease (IBD) should be vaccinated. However, response to vaccination in this population seems to be poorer than in healthy people. The aim of this study is to assess which clinical, analytical and immunosuppressive therapy parameters affect the response to hepatitis B vaccination in patients with IBD. A follow-up including monitoring of the immunosuppressive therapy of a cohort of 123 patients with IBD was carried out after each round of vaccination against hepatitis B virus. The recombinant HBsAg vaccine (20 μg) was administered using the standard regimen (0, 1 and 6 months). Anti-HBs values >10I U/L after 1-3 months post-vaccination were considered as a successful response to vaccination. One hundred and five patients (85.5%) completed the programme and response to vaccination was observed in 50 (47.6%) patients. Multivariate analysis showed an independent relationship, with weaker response to vaccination, for IBD duration equal to or longer than 110 months [adjusted OR (95% CI): 0.282 (0.114-0.701)], serum albumin levels below 3.6 mg/dl at the beginning of vaccination [adjusted OR (95% CI): 0.336 (0.112-1.009)], and corticosteroid therapy in more than one vaccination dose [adjusted OR (95% CI): 0.333 (0.135-0.820)]. This study confirms the poor response to hepatitis B vaccination in patients with IBD, being particularly weak in individuals with long-term IBD progression, low serum albumin levels and those on corticosteroid therapy.