Utility of a Third Heplisav-B Dose in Patients with Inflammatory Bowel Disease without Immunity Following Two-Dose Heplisav-B Vaccination

Christian Karime; Cecily N Black; Pedro Cortes; Joshua Y Kwon; Freddy Caldera; Shenna K Crosby; Michael F Picco; Jami A Kinnucan; Jana G Hashash; Francis A Farraye

doi:10.14309/ajg.0000000000002863

Utility of a Third Heplisav-B Dose in Patients with Inflammatory Bowel Disease without Immunity Following Two-Dose Heplisav-B Vaccination

Am J Gastroenterol. 2024 May 8. doi: 10.14309/ajg.0000000000002863. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
² Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
³ Department of Pharmacy, Mayo Clinic, Jacksonville, Florida, USA.
⁴ Inflammatory Bowel Disease Centre, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.

PMID: 38717045
DOI: 10.14309/ajg.0000000000002863

Abstract

Objectives: Hepatitis B virus (HBV) vaccination is recommended in patients with inflammatory bowel disease (IBD). Although the two-dose Heplisav-B vaccine has proven effective, more than 20% of patients with IBD do not seroconvert. We prospectively evaluated the effectiveness of a third Heplisav-B dose in patients with IBD lacking HBV immunity despite two-dose vaccination.

Methods: Adults with IBD who had received two-dose Heplisav-B vaccination between 2018-2023 were identified. Seroconversion was defined as hepatitis B surface antibody (HBsAb) >10 IU/L measured at >4 weeks following vaccination. Patients who did not seroconvert were prospectively offered a third Heplisav-B dose, followed by repeat HBsAb measurement. Demographic, clinical, medication, and vaccination data was compared between those who did and did not seroconvert.

Results: Of 192 patients identified, 71.9% (138/192) seroconverted following two-dose Heplisav-B vaccination. The 54 patients (28.1%) who did not seroconvert were more likely to be male, have diabetes, chronic kidney disease, or elevated Charlson Comorbidity Index. Of the 54 patients, 30 (55.6%) elected to receive a third Heplisav-B dose, with 56.7% (17/30) achieving seroconversion (median HBsAb titer 376 IU/L, IQR 47-1000 IU/L) despite a median inter-vaccination time of 416 days (IQR 90.8-667.8). No differences were noted between patients who did versus did not seroconvert following third dose vaccination.

Conclusion: In patients with IBD lacking HBV immunity despite two-dose Heplisav-B vaccination, administration of a third dose resulted in a 56.7% seroconversion rate. Our results suggest that administration of an additional Heplisav-B dose may be an effective strategy in patients lacking immunity despite primary two-dose vaccination.