Maintaining Hepatitis B Protection in Immunocompromised Pediatric Rheumatology and Inflammatory Bowel Disease Patients

2020 ◽  
pp. jrheum.200283
Author(s):  
Najla Aljaberi ◽  
Enas Ghulam ◽  
Emily A. Smitherman ◽  
Leslie Favier ◽  
Dana M.H. Dykes ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Hepatitis B ◽  
Bowel Disease ◽  
Immunocompromised Patients ◽  
Duration Of Treatment ◽  
Hbv Vaccine ◽  
Booster Vaccine ◽  
Significant Difference ◽  
Inflammatory Bowel ◽  
Hbv Screening

Objective Hepatitis B virus (HBV) infection remains a significant public health challenge, particularly for immunocompromised patients. Our aim was to evaluate the serologic immunity in immunocompromised rheumatology and inflammatory bowel disease (IBD) patients, assess factors for serologic non-immunity and evaluate their response to one HBV booster dose. Methods Immunocompromised rheumatology and IBD patients with completed HBV screening were identified. A chart review was performed to collect demographics, clinical information, baseline HBV serology results, and serologic response to booster vaccination. Serologic nonimmunity was defined as a negative/indeterminate hepatitis B surface antibody (anti-HBs) level. Results Among 580 patients, 71% were non-immune. The highest portion of non-immune patients were 11-18 years old (p 0.004). There was no significant difference between immune and non-immune patients with regards to diagnosis (p 0.342), age at diagnosis (p 0.639), duration of treatment (p 0.069) or type of medications (p 0.080). Sixty-two percent of those who received a booster vaccine were re-screened, and most (68%) seroconverted. In those 18 years or older, only half seroconverted. Conclusion Results of this study support the benefit of HBV screening in immunosuppressed patients. Beginning at age 11 years most patients lacked serologic immunity to HBV. Seroconversion for most patients 11-18 years occurred after one booster vaccine. Thus, for immunocompromised patients without recent HBV serologic data, obtaining the HBV serology beginning at age 11 years might be considered. Those 18 years and older were least likely to seroconvert after one booster, indicating that they may benefit from receiving the three-dose HBV vaccine series.

scholarly journals The Immunogenicity of the Influenza, Pneumococcal, and Hepatitis B Vaccines in Patients With Inflammatory Bowel Disease Treated With Vedolizumab

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Jill E Harrington ◽  
Rachel E Hamilton ◽  
Lisa Ganley-Leal ◽  
Francis A Farraye ◽  
Sharmeel K Wasan
Keyword(s):  
Inflammatory Bowel Disease ◽  
Hepatitis B ◽  
Adverse Events ◽  
Influenza Vaccine ◽  
Disease Activity ◽  
Bowel Disease ◽  
Hepatitis B Vaccine ◽  
Significant Difference ◽  
Hepatitis B Vaccines ◽  
Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) have an elevated risk for infection which is further increased by immunosuppressive medications. The aim of this study was to evaluate the safety and immunogenicity of influenza, PVC13, PPSV23, and hepatitis B vaccines in adults with IBD treated with vedolizumab as compared to those treated with anti-tumor necrosis factor (TNF) agents or nonimmunosuppressive therapy. Methods In this prospective controlled trial, patients were vaccinated with the influenza, PVC13, PPSV23, and/or hepatitis B vaccines. Participants were grouped based on IBD medication regimen: (1) vedolizumab monotherapy, (2) vedolizumab plus immunomodulator, (3) anti-TNF plus immunomodulator, and (4) no immunosuppressive therapy (control). Vaccine responses were evaluated by comparing pre- and postvaccination titers. Disease activity and adverse events were monitored by the Harvey–Bradshaw Index or Simple Colitis Clinical Activity Index and by standardized phone interviews. Results No serious adverse events or significant changes in disease activity were reported. For the influenza vaccine, baseline titers were high in all groups, and no follow-up titers met criteria for adequate response. For the pneumococcal vaccines, all groups showed response to vaccination; there was no statistically significant difference between the groups. For the hepatitis B vaccine, 62.5% of patients receiving vedolizumab and 33.3% receiving anti-TNF therapy achieved a level of response >10 mIU/mL. Discussion The inability to observe a response to the influenza vaccine was influenced by high baseline titers. For the hepatitis B vaccine, patients treated with vedolizumab experienced immunogenic response to vaccination that was noninferior to nonimmunosuppressed controls. All studied vaccines were well-tolerated. Vaccination should be encouraged in all adult patients with IBD.

scholarly journals SAT0462 ASSESSMENT OF BONE MINERAL DENSITY IN INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1188.1-1188
Author(s):  
C. Daldoul ◽  
N. El Amri ◽  
K. Baccouche ◽  
H. Zeglaoui ◽  
E. Bouajina
Keyword(s):  
Bone Mineral Density ◽  
Inflammatory Bowel Disease ◽  
Bone Mineral ◽  
Bowel Disease ◽  
Mineral Density ◽  
Femoral Site ◽  
Significant Difference ◽  
History Of ◽  
Inflammatory Bowel ◽  
The Mean

Background:Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is considered as a risk factor of low bone mineral density (BMD). In fact, the prevalence of osteoporosis ranges from 17% to 41% in IBD patients. The possible contributing factors may include malabsorption, glucocorticoid treatment and coexisting comorbiditiesObjectives:The purpose of our work was to determine the frequency and the determinants of osteoporosis in patients with IBD and to assess whether there is a difference in BMD status between UC and CD.Methods:This is a retrospective study, over a period of 5 years (from January 2014 to December 2018) and including patients followed for IBD who had a measurement of BMD by DEXA. Clinical, anthropometric and densitometric data (BMD at the femoral and vertebral site) were recorded. The WHO criteria for the definition of osteoporosis and osteopenia were applied.Results:One hundred and five patients were collected; among them 45 were men and 60 were women. The average age was 45.89 years old. The average body mass index (BMI) was 25.81 kg/m2 [16.44-44.15]. CD and UC were diagnosed in respectively 57.1% and 42.9%. A personal history of fragility fracture was noted in 4.8%. Hypothyroidism was associated in one case. Early menopause was recorded in 7.6%. 46.8% patients were treated with corticosteroids. The mean BMD at the vertebral site was 1.023 g/cm3 [0.569-1.489 g/cm3]. Mean BMD at the femoral site was 0.920g/cm3 [0.553-1.286g / cm3]. The mean T-score at the femoral site and the vertebral site were -1.04 SD and -1.27 SD, respectively. Osteoporosis was found in 25.7% and osteopenia in 37.1%. Osteoporosis among CD and UC patients was found in respectively 63% and 37%. The age of the osteoporotic patients was significantly higher compared to those who were not osteoporotic (52.23 vs 43.67 years, p = 0.01). We found a significantly higher percentage of osteoporosis among men compared to women (35.6% vs 18.3%, p=0.046). The BMI was significantly lower in the osteoporotic patients (23.87 vs 26.48 kg/m2, p=0.035) and we found a significant correlation between BMI and BMD at the femoral site (p=0.01). No increase in the frequency of osteoporosis was noted in patients treated with corticosteroids (27.9% vs 21.6%, p=0.479). Comparing the UC and CD patients, no difference was found in baseline characteristics, use of steroids or history of fracture. No statistically significant difference was found between UC and CD patients for osteoporosis(p=0.478), BMD at the femoral site (p=0.529) and at the vertebral site (p=0.568).Conclusion:Osteoporosis was found in 25.7% of IBD patients without any difference between CD and UC. This decline does not seem to be related to the treatment with corticosteroids but rather to the disease itself. Hence the interest of an early screening of this silent disease.Disclosure of Interests:None declared

scholarly journals A183 TELEHEALTH USE IN RURAL SASKATCHEWAN AND INFLAMMATORY BOWEL DISEASE OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 197-199
Author(s):  
M Patterson ◽  
M Gozdzik ◽  
J Peña-Sánchez ◽  
S Fowler
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
Postal Code ◽  
Care Utilization ◽  
Specialist Care ◽  
Disease Characteristics ◽  
Significant Difference ◽  
Inflammatory Bowel

Abstract Background Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient’s personal phones. Aims The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods A retrospective chart review was completed on all rural patients (postal code S0*) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups; although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care. Funding Agencies None

Liver dysfunction related to hepatitis B and C in patients with inflammatory bowel disease treated with immunosuppressive therapy

Gut ◽  
2010 ◽  
Vol 59 (10) ◽  
pp. 1340-1346 ◽  
Author(s):  
C. Loras ◽  
J. P. Gisbert ◽  
M. Minguez ◽  
O. Merino ◽  
L. Bujanda ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Hepatitis B ◽  
Immunosuppressive Therapy ◽  
Liver Dysfunction ◽  
Bowel Disease ◽  
Inflammatory Bowel

Sa1124 A Report on the Prevalence and Reactivation Rate of Hepatitis B Virus in Patients With Inflammatory Bowel Disease in Japan

2014 ◽  
Vol 146 (5) ◽  
pp. S-206
Author(s):  
Yoko Yokoyama ◽  
Mikio Kawai ◽  
Koji Kamikozuru ◽  
Masaki Iimuro ◽  
Nobuyuki Hida ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Bowel Disease ◽  
B Virus ◽  
Inflammatory Bowel

scholarly journals Hepatitis B Virus Reactivation Induced by Infliximab Administration in a Patient with Crohn’s Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Yuka Miyake ◽  
Aki Hasebe ◽  
Tetsuya Tanihira ◽  
Akiko Shiraishi ◽  
Yusuke Imai ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Hepatitis B Virus ◽  
Crohn's Disease ◽  
Hepatitis B ◽  
Bowel Disease ◽  
Hbv Dna ◽  
Hbv Reactivation ◽  
B Virus ◽  
Inflammatory Bowel

A 47-year-old man diagnosed with Crohn’s disease was treated with infliximab. He tested negative for hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) but positive for anti-HB core antibody (anti-HBc). He tested positive for hepatitis B virus (HBV-) DNA 3 months after treatment and was administered entecavir. HBV-DNA test showed negative results 1 month later. ALT was persistently within the normal range, and HBV-DNA was persistently negative thereafter despite the continuation of infliximab every 8 weeks. In our hospital, 14 patients with inflammatory bowel disease, who tested negative for HBsAg, were treated with infliximab; 2 of them tested positive for anti-HBs and/or anti-HBc, and HBV reactivation was observed in 1 patient (the present patient). The present case and these findings highlight that careful follow-up is needed in patients with inflammatory bowel disease treated with infliximab who test positive for anti-HBc and/or anti-HBs.

scholarly journals P803 Non-immunity against hepatitis B virus in patients with newly diagnosed inflammatory bowel disease

2018 ◽  
Vol 12 (supplement_1) ◽  
pp. S518-S518
Author(s):  
H S Lee ◽  
S J Yeo ◽  
E S Kim ◽  
B I Jang ◽  
Y J Lee ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Bowel Disease ◽  
Newly Diagnosed ◽  
B Virus ◽  
Inflammatory Bowel

scholarly journals Predicting 30-Day Readmission Rate in Inflammatory Bowel Disease Patients: Performance of LACE Index

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Lauren A George ◽  
Brendan Martin ◽  
Neil Gupta ◽  
Nikhil Shastri ◽  
Mukund Venu ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Readmission Rate ◽  
Risk Group ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Unplanned Readmission ◽  
Significant Difference ◽  
Inflammatory Bowel

AbstractBackground and AimsReadmission within 30 days in inflammatory bowel disease (IBD) patients increases treatment costs and serves as a quality indicator. The LACE (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency Department visits in past 6 months) index is used to predict the risk of unplanned readmission within 30 days. The aim of this study was to evaluate the accuracy of using the LACE index in IBD.MethodsCalculation of LACE index was done prospectively for IBD patients admitted to a single tertiary care center. Patient, disease, and treatment characteristics, as well as index hospitalization characteristics including indication for admission and disease activity measures were retrospectively recorded. Descriptive statistics and univariable exact logistic regression analyses were performed.ResultsIn total, 64 IBD patients were admitted during the study period. The 30-day readmission rate of IBD patients was 19% and overall median LACE index was 6, with IQR 6–7. LACE index categorized 16% of IBD patients in low-risk group, 82% in moderate risk group, and 2% in high-risk group. LACE index did not predict 30-day readmission (OR 1.35, CI: 0.88–2.18, P = 0.19). There was no significant difference in 30-day readmission rates with inpatient antibiotic or narcotic use, admission C-reactive protein (CRP), anemia, IBD duration, maintenance therapy, or prior IBD operation. For every 1 day increase in length of stay (LOS), patients were 8% more likely (OR: 1.08, 95% CI: 1.00–1.16) to be readmitted within 30 days (P = .05).ConclusionsLACE index does not accurately identify 30-day readmission risk in the IBD population. As increased LOS is associated with higher risk, there may be benefit for targeted strategic resource allocation via specialized services.

Prognosis of Lymphoma in Patients With Known Inflammatory Bowel Disease: A French Multicentre Cohort Study

2020 ◽  
Vol 14 (9) ◽  
pp. 1222-1230 ◽  
Author(s):  
T Severyns ◽  
J Kirchgesner ◽  
J Lambert ◽  
C Thieblemont ◽  
A Amiot ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
B Cell ◽  
Bowel Disease ◽  
Cohort Analysis ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
B Cell Lymphomas ◽  
Free Survival ◽  
Significant Difference ◽  
Inflammatory Bowel

Abstract Background and Aims The prognosis of lymphoma that occurs in patients with inflammatory bowel disease [IBD] is poorly known. Methods A multicentre retrospective cohort analysis was done in seven French tertiary centres from 1999 to 2019. Only lymphoma occurring in patients with previous established diagnosis of IBD were analysed. The primary outcome was progression-free survival at 3 years. Results A total of 52 patients [male 65%, Crohn’s disease 79%, median age 48.3 years, median duration of IBD 10.1 years] were included, of whom 37 had been previously exposed to immunosuppressants and/or biologics for at least 3 months and 20 had primary intestinal lymphomas. The lymphoma histological types were: diffuse large B cell lymphomas [N = 17], Hodgkin lymphomas [N = 17], indolent B cell lymphomas [N = 12], and others including T cell lymphomas, mantle cell lymphomas, and unclassifiable B cell lymphoma [N = 6]. The median follow-up after lymphoma was 5.1 years (interquartile range [IQR] 4–7.8). Progression-free survival at 3 years was 85% in the overall population (95% confidence interval [CI] 75%–96%) with no significant difference between the exposed and unexposed group, 79% for patients exposed to immunosuppressants and/or biologics [95% CI 67%–94%], and 83% for patients diagnosed with primary intestinal lymphoma [95% CI 67%–100%]. No relapse of IBD has been observed during chemotherapy. The IBD relapse rate at the end of the last chemotherapy cycle was 23% at 3 years [95% CI 11%-39%] in the overall population. Conclusions In this large cohort, the prognosis for lymphomas occurring in IBD appears to be good and similar to what is expected, irrespective of the exposure to biologics and/or immunosuppressants.

scholarly journals Prevalence of Joint Hypermobility and Patterns of Articular Manifestations in Patients with Inflammatory Bowel Disease

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
P. Vounotrypidis ◽  
E. Efremidou ◽  
P. Zezos ◽  
M. Pitiakoudis ◽  
E. Maltezos ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Study Groups ◽  
Joint Hypermobility ◽  
Fisher Exact Test ◽  
Hypermobility Syndrome ◽  
Exact Test ◽  
Significant Difference ◽  
Healthy Control ◽  
Inflammatory Bowel

Objective. The objective is the investigation of Joint Hypermobility (JH) and the Hypermobility Syndrome (HMS) in patients with inflammatory bowel disease (IBD).Methods. We examined 83 patients with IBD and 67 healthy individuals for the presence of JH. Patients were excluded if they were under 18 or over 50 years of age and if they had other conditions which affect joint mobility. Thex2and the Fisher exact test were used appropriately between study groups. Odds ratios (ORs) for the risk of JH and HMS in IBD groups were calculated.Results. A total of 150 individuals (83 IBD patients and 67 healthy controls) participated in the study. 69 IBD patients, 41 with Crohn's Disease (CD) and 28 with ulcerative colitis (UC), were finally eligible. JH was detected in 29 CD patients (70.7%), in 10 UC patients (35.7%), and in 17 healthy control subjects (25.4%). Significant difference was detected on JH in CD patients as compared to UC patients (P=.0063) and controls (P<.0001). The estimated OR for JH was 7.108 (95% CI: 2.98–16.95) in CD and 1.634 (95% CI: 0.63–4.22) in UC patients. HMS was detected in 5 (12.2%) CD and in 1 (3.57%) UC patients. The OR for HMS in CD was 3.75 (95% CI: 0.41–34.007), while 7 (17.1%) CD patients had overlapping symptoms for both HMS and early spondylarthropathy.Conclusions. JH and the HMS are common in CD patients, thus articular manifestations should be carefully interpreted. This implies an involvement of collagen varieties in the pathogenesis of IBD.

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