title: Comparison of the effectiveness of two protocols for vaccination (standard and double dosage) against hepatitis B virus in patients with inflammatory bowel disease.
abstract: BACKGROUND
  The response rate to hepatitis B virus (HBV) vaccination in patients with inflammatory bowel disease (IBD) is low.
  
  
  OBJECTIVE
  To compare two vaccination protocols-the standard dose and the double dose-in IBD patients.
  
  
  METHODS
  Patients diagnosed with IBD from three tertiary hospitals were vaccinated against HBV with two different protocols: the standard protocol (Engerix-B single dose at 0, 1 and 6 months) and the new faster protocol based on a double dose (Engerix B double dose at 0, 1 and 2 months). Anti-HBs titres were measured 1-3 months after the last dose. A multivariate analysis was performed to identify factors that were predictive of response to the vaccine.
  
  
  RESULTS
  The study sample comprised 148 patients (mean age 40 years, 69% Crohn's disease), 70% of whom were receiving immunosuppressive therapy (22% thiopurines, 23% anti-TNF and 25% both). The standard protocol was followed in 46% of patients and the double dose protocol in 54%. Considering anti-HBs >10 IU/L as a successful response to vaccination, the seroconversion rate was higher among patients vaccinated with the double dose than with the standard dose: 75% (95% CI, 65-85%) vs. 41% (95% CI, 29-54%) (P < 0.001). In the multivariate analysis, vaccination with the double dose was the only factor associated with a better response to the vaccine (OR, 4; 95% CI, 2-8; P < 0.001).
  
  
  CONCLUSIONS
  The response rate to the HBV vaccination in IBD patients is low. Administration of a double dose was associated with a higher response rate. Therefore, the double dose protocol could be a suitable option in patients with IBD.
authors.affiliation: Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain. gisbert@meditex.es
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: L
authors.initials: L
authors.lastname: Menchén
authors.forename: V
authors.initials: V
authors.lastname: García-Sánchez
authors.forename: I
authors.initials: I
authors.lastname: Marín
authors.forename: J R
authors.initials: JR
authors.lastname: Villagrasa
authors.forename: M
authors.initials: M
authors.lastname: Chaparro
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D014611:Vaccination / Q000379:methods*
chemical_list: D017325:Hepatitis B Vaccines; D007166:Immunosuppressive Agents