title: Impact of surveillance of hepatitis b and hepatitis c in patients with inflammatory bowel disease under anti-TNF therapies: multicenter prospective observational study (REPENTINA 3).
abstract: OBJECTIVE
  Assess IBD patients starting anti-TNF for the impact of preventive measures in HBV and/or HCV, and the predictive response factors to HBV vaccination.
  
  
  METHODS
  Multicenter prospective study including 389 IBD patients. Four interventions were established: I-1) anti-HBs <100IU/L: HBV vaccination with double doses at 0-1-2months, and revaccination if titres <100IU/L (seroprotection defined as anti-HBs10-100IU/L and effective vaccination anti-HBs >100IU/L); I-2) anti-HBs >100IU/L (previous effective vaccination): monitoring levels; I-3) anti-HBc and/or HCV+: analysis every two months; I-4) HBsAg+: start anti-virals.
  
  
  RESULTS
  I-1 and I-2) For first vaccination, effective vaccination and seroprotection were obtained in 26.4% and 43.5%, and for revaccination 31.3% and 44.4%, respectively. Predictive factors of effective vaccination were age ≤30years (OR=2.2) and being vaccinated simultaneously with anti-TNF (OR=5.2) instead of late vaccination, whereas age ≤30years (OR=2.6) and anti-TNF monotherapy (OR=2.4) were predictive for seroprotection. 80.8% of patients previously vaccinated maintained titres at 29months follow-up. The only factor related to maintaining titres was previous vaccination versus achieving effective vaccination during anti-TNF (HR=2.49); I-3 and I-4) HBV-DNA + without reactivation was detected in 7% of 29 anti-HBc. No reactivation was found in the remaining HCV (n=5) or HBsAg (n=4) patients.
  
  
  CONCLUSIONS
  1) Response to vaccination/revaccination is low in patients with anti-TNF. Young patients vaccinated at the beginning of anti-TNF and receiving it as a monotheraphy showed better response. 2) Long-lasting effective vaccination is greatest in patients previously vaccinated. 3) Following-up the established surveillance and/or preventive anti-viral therapy seems to be safe in HBV and HCV patients.
authors: Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors: C
authors: C
authors: Loras
authors: Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors: J P
authors: JP
authors: Gisbert
authors: Department of Gastroenterology, Hospital de Cabueñes, Gijón, Asturias, Spain.
authors: M C
authors: MC
authors: Saro
authors: Department of Gastroenterology, Consorci Sanitari de Terrassa, Catalonia, Spain.
authors: M
authors: M
authors: Piqueras
authors: Department of Gastroenterology, Hospital Universitari la Fe, Valencia, Spain.
authors: C
authors: C
authors: Sánchez-Montes
authors: Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
authors: J
authors: J
authors: Barrio
authors: Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors: I
authors: I
authors: Ordás
authors: Department of Gastroenterology, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí de Sabadell, Catalonia, Spain.
authors: A
authors: A
authors: Montserrat
authors: Department of Gastroenterology, Hospital Santiago de Compostela, Santiago de Compostela, Galicia, Spain.
authors: R
authors: R
authors: Ferreiro
authors: Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors: Y
authors: Y
authors: Zabana
authors: Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors: M
authors: M
authors: Chaparro
authors: Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors: F
authors: F
authors: Fernández-Bañares
authors: Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Electronic address: mestevecomas@telefonica.net.
authors: M
authors: M
authors: Esteve
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D000068582:Certolizumab Pegol; D004279:DNA, Viral / Q000097:blood; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines; D006515:Hepatitis B virus / Q000235:genetics / Q000502:physiology; D006526:Hepatitis C / Q000276:immunology*; D006801:Humans; D007117:Immunization, Secondary; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D000069285:Infliximab; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014611:Vaccination; D014775:Virus Activation; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D004279:DNA, Viral; C075654:Engerix-B; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007140:Immunoglobulin Fab Fragments; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol
keywords: Anti-TNF treatment; Hepatitis B; Hepatitis B vaccination; Hepatitis C; Inflammatory bowel disease