Immune response to Hepatitis B vaccine in patients with celiac disease: A systematic review and meta-analysis

Area of Science:

• Immunology
• Gastroenterology
• Vaccinology

Background:

• Celiac disease (CD) is an autoimmune disorder affecting the small intestine.
• The immune response to vaccinations, including the hepatitis B virus (HBV) vaccine, may be altered in individuals with CD.
• Previous studies have yielded conflicting results regarding the efficacy of HBV vaccination in CD patients.

Purpose of the Study:

• To conduct a literature review and meta-analysis to evaluate the protective antibody response to HBV vaccination in patients with celiac disease.
• To compare the frequency of non-protective antibody responses in CD patients versus non-affected individuals.

Main Methods:

• Systematic literature search for randomized controlled trials (RCTs) and observational controlled studies.
• Meta-analysis of studies reporting anti-HBs (HBsAb) titers ≥ 10 IU/L after the last vaccine dose.
• Calculation of rate ratios (RR) and assessment of heterogeneity using I² statistic and funnel plots.
• Meta-regression analysis to explore study-specific variables influencing effect size.

Main Results:

• The meta-analysis included 12 retrospective studies (1,447 participants) and 4 prospective studies (184 participants).
• A significantly higher frequency of non-protective antibody responses was observed in CD patients compared to controls.
• Rate ratios (RR) for protective response were 0.777 (95% C.I.: 0.629-0.960) for retrospective and 0.732 (95% C.I.: 0.664-0.808) for prospective studies.
• Moderate heterogeneity was noted (I² = 51.1% retrospective, 39.8% prospective).

Conclusions:

• Patients with celiac disease exhibit a more frequent occurrence of non-protective antibody responses following HBV vaccination.
• The findings suggest a potentially diminished vaccine efficacy in this population.
• Further high-quality clinical trials are warranted to definitively assess post-vaccination HBsAb titers in CD patients and inform vaccination strategies.