People with RA are significantly less likely to respond to hepatitis B vaccination compared to the general population, research presented at EULAr shows.

Results of the trial of 60 RA patients and 156 matched controls found that only 11% of RA patients  responded to the vaccine, compared with 83% of those without RA.

“The majority of RA patients tested as part of our study were not protected by hepatitis B vaccination,” said study investigator Dr. Misha Tilanus, Radboud University Medical Centre, Netherlands.

“People with RA have an increased risk of morbidity and mortality from infections, and to discover that immunisation might not confer protection is a real concern. It’s crucial that patients and healthcare practitioners are aware of this lack of efficacy and do all they can to minimise risk.”

Options in clinical practice included vaccinating a patient before they  start treatment but if that wasn’t possible booster doses or an increased dose could be used, said Dr Tilanus in an interview.

“Or you can use Engerix-B as the literature shows it provides higher level of antibodies… and perhaps that’s better for RA patients,” she said.

Vaccination with HBVAXPRO-10 was performed according to the standard regimen (0, 1 and 6 months), with markers of response to the vaccine (hepatitis B antigens, anti-HBsAG) determined after 28 weeks.

RA patients had a higher risk for non-response than controls, with an odds ratio of 44 (corrected for age and gender). There was no difference in response between patients using anti- TNF, DMARDs or rituximab.