高剂量，加速肝炎疫苗接种可以改善反应

StephenW

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.

StephenW

高剂量，加速肝炎疫苗接种可以改善反应

Wigg AJ，et al。 Clin Gastroenterol Hepatol。 2018; DOI：10.1016 / j.cgh.2018.08.047。
2018年8月23日

最近一项研究的结果显示，肝硬化患者最初接受高剂量，加速甲型肝炎疫苗接种的潜在益处包括改善免疫反应，同时将成本降至最低。

“肝硬化患者的甲型肝炎（HAV）和乙型肝炎（HBV）感染发病率增加，对这些感染的疫苗接种是重要的护理标准，”来自澳大利亚阿德莱德弗林德斯医疗中心的Alan J. Wigg博士说。和同事写道。 “然而，肝硬化患者的疫苗接种受到免疫功能障碍的阻碍，并且现有的高质量文献数量有限。”


在HAV研究组中，73名患者在基线，1个月和6个月时接受标准Twinrix（GlaxoSmithKline）剂量720μg，而35名患者在基线，1个月和6个月时接受标准剂量的两倍。

同样，HBV研究组包括97名在基线，1个月和6个月接受标准20μg剂量的Twinrix或Engerix（GlaxoSmithKline）的患者，而51名患者在基线，1个月和2个月时接受标准剂量的两倍。

与标准剂量相比，接受高剂量，加速HAV疫苗接种的患者具有较高的初始应答率（94.3％对79.5％）和较高的每种方案免疫应答率（100％对94.3％）。然而，结果没有达到显着性。

HBV的两种疫苗接种策略对于初始响应率和每个方案响应率具有相似的结果。

研究人员指出，多变量分析显示，HBV研究中的低白蛋白与免疫无应答显着相关。此外，他们报告没有与疫苗接种相关的严重不良事件。

Wigg及其同事写道：“结果不支持肝硬化患者常规[高剂量，加速] HBV疫苗接种方案的常规使用，但确实可以从[高剂量，加速]加强初始无应答者中获益。” “我们相信这项研究结果为未来随机，充分动力的研究提供了理论依据，这些研究调查了肝硬化患者的初始HAV [高剂量，加速]方案和继发性HBV [高剂量，加速]加强方案的益处。” - by Talitha Bennett

披露：作者报告没有相关的财务披露。