|
By Naim Alkhouri, MD, and Jonathan Moses, MD
The use of biologic agents has revolutionized the treatment of inflammatory bowel disease (IBD) in children as well as adults. Checking hepatitis B virus (HBV) immunity should be strongly considered before starting children with IBD on the commonly used biologic infliximab.
Biologics are potent immunosuppressants. Children on infliximab risk the development of severe liver disease if they lack HBV immunity and are exposed to the virus or if they are chronic carriers and
HBV is reactivated.
100 children serologically tested
We conducted a prospective, cross-sectional study to determine HBV immunity and prior exposure in 100 Cleveland Clinic Children's Hospital patients on infliximab therapy for IBD. Their mean age was 17.8
(± 4.0) years.
Serologic testing revealed that no patients were positive for HBsAg or anti-HBc. However, regardless of vaccination history, just 49 percent of the patients in our cohort had protective anti-HBs levels
(≥10 mIU/mL).
54 percent had lost immunity
Accessing the vaccination records of 67 patients, we found that 61 (91 percent) had received HBV vaccination, and six (9 percent) had not. Only 28 vaccinated patients (46 percent) were considered immune to HBV.
Concurrent use of infliximab did not affect HBV immunity. We provided booster doses of HBV vaccine for 34 patients and started the full series in eight patients. Data on their responses to vaccination
is pending.
About the Authors
Dr. Alkhouri is a staff physician and Dr. Moses is a fellow who works with him and with Christine Carter-Kent, MD, in the Department of Pediatric Gastroenterology. Other authors were Ariel Feldstein, MD, Robert N. Wyllie, MD, and Nizar Zein, MD, of the Department of Gastroenterology and Hepatology.
To refer patients to Children's Hospital gastroenterologists, call 216.444.9000. Physicians may reach Dr. Alkhouri at [email protected].
This study was presented at the 2010 American College of Gastroenterology and the North American Pediatric Gastroenterology, Hepatology, and Nutrition Society meetings in October.
Return to Current Issue
|
