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)

Aims: 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 100 IU/L); I-2) anti-HBs >100 1U/L (previous effective vaccination): monitoring levels; I-3) anti-HBc and/or HCV+: analysis every two months; 1-4) 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 30 years (OR = 2.2) and being vaccinated simultaneously with anti-TNF (OR = 5.2) instead of late vaccination, whereas age 30 years (OR = 2.6) and anti-TNF monotherapy (OR = 2.4) were predictive for seroprotection. 80.8% of patients previously vaccinated maintained titres at 29 months 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 1-4) 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. (C) 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.