High-dose, accelerated hepatitis vaccination may improve response
Wigg AJ, et al. Clin Gastroenterol Hepatol. 2018;doi:10.1016/j.cgh.2018.08.047.
August 23, 2018
Results from a recent study showed a potential benefit from initial high-dose, accelerated hepatitis A vaccination in patients with cirrhosis including improved immune response with minimal increased cost.
“Patients with cirrhosis have increased morbidity from hepatitis A (HAV) and B (HBV) infections, and vaccination against these infections is an important standard of care,” Alan J. Wigg, PhD, from the Flinders Medical Center in Adelaide, Australia, and colleagues wrote. “However, vaccination in patients with cirrhosis is hindered by immune dysfunction and there is limited high quality literature available.”
In the HAV study arm, 73 patients received the standard Twinrix (GlaxoSmithKline) dose of 720 µg at baseline, 1 month and 6 months, while 35 patients received twice the standard dose at baseline, 1 month and 6 months.
Similarly, the HBV study arm included 97 patients who received a standard 20 µg dose of either Twinrix or Engerix (GlaxoSmithKline) at baseline, 1 month and 6 months, while 51 patients received twice the standard dose at baseline, 1 month and 2 months.
Patients who received the high-dose, accelerated HAV vaccinations had higher initial response rates (94.3% vs. 79.5%) and higher per protocol immune response rates (100% vs. 94.3%) compared with the standard dose. The results did not reach significance, however.
Both vaccination strategies for HBV had similar results for initial response rates and per protocol response rates.
The researchers noted that low albumin in the HBV study correlated significantly with immune non-response after multivariate analysis. Additionally, they reported no vaccination-related serious adverse events.
“Results do not support the routine use of the initial [high-dose, accelerated] HBV vaccination regimen in cirrhotic patients, but do suggest a potential benefit from [high-dose, accelerated] boosting of initial nonresponders,” Wigg and colleagues wrote. “We believe the study findings provide the rationale for future randomized, adequately powered studies investigating benefits of an initial HAV [high-dose, accelerated] regimen and a secondary HBV [high-dose, accelerated] boosting regimen in cirrhotic patients.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures. 作者: StephenW 时间: 2018-8-25 16:04