Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence.
BACKGROUND
Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study examines the efficacy and patient preference of subcutaneous (SC) administration of HBIG in maintaining anti HBs titres > 100 IU/L.


METHODS
12 patients who were stable while receiving our standard IM HBIG protocol received an alternate formulation by SC injection, consisting of 10 mL (3120 IU) HBIG as 4 x 2.5 mL SC injections. SC injection were repeated as soon as titres reached 100-150 IU/mL during the 3 month study period. A questionnaire was administered upon study entry and exit to subjectively assess patient preference.


RESULTS
Anti- HBs Cmax after first injection was 441.6 IU/L +/- 81.5, and Tmax was 7.1 +/- 3.2 days. SC injections were required every 56 days, which compared well to the frequency of required IM injections prior to study enrollment of 45 days. The patients mean ratings of pain on a 0-10 scale were 5 for the IM route and 1.6 for the SC route. All patients preferred the SC injections to the IM.


CONCLUSIONS
SC administration of HBIG can effectively maintain anti HBs levels above the requisite 100 IU/L while substantially decreasing patient discomfort and improving patient satisfaction, and therefore becomes a very attractive alternative to IM HBIG injections. Further studies and wider use of SC HBIG based on this study may alter the standard practice of transplantation centers<br />
Singham
Janakie
J
University of British Columbia, Vancouver BC, Canada.
Greanya
Erica D
ED
Lau
Kirby
K
Erb
Siegfried R
SR
Partovi
Nilu
N
Yoshida
Eric M
EM
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001955:British Columbia; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010865:Pilot Projects; D011446:Prospective Studies; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin