Response to hepatitis B vaccination impaired in rheumatoid arthritis patients

Most rheumatoid arthritis patients taking immune-suppressant drugs do not have an adequate response to hepatitis B vaccination, reveal data^[1] presented at the Annual European Congress of Rheumatology (EULAR) on 12 June 2015.

Rheumatoid arthritis patients are at increased risk of infection, both because of their auto-immune disease and because they are put on immune-suppressant medication. Vaccination against influenza and pneumococcal infections is recommended to protect patients from these diseases. Studies have shown that the response to these vaccinations is only slightly below the response of the general population but it is possible that response to other vaccinations may be impaired.

In this study, the standard three-dose hepatitis B vaccination regimen was given to rheumatoid arthritis patients (n=47) and a control group made up of healthcare professionals (n=156). After 28 weeks, only 11% of the rheumatoid arthritis patients had an adequate response, compared with 83% of the control group (P<0.001). There was no difference in response between patients taking disease-modifying anti-rheumatic drugs, rituximab or anti-TNF therapy.

In developed countries, hepatitis B is only a concern for groups at specific risk of infection, such as healthcare professionals and injecting drug users. But the results of the study suggest that rheumatoid arthritis patients who are given any kind of vaccination should have their immune response analysed, said Misha Tilanus, Radbound University Medical Centre, Netherlands.

An inadequate response to vaccination can occur even in a healthy population and Tilanus said that using additional or higher doses can improve response in these patients.