Two-Dose Hepatitis B Vaccine (Heplisav-B) Results in Better Seroconversion Than Three-Dose Vaccine (Engerix-B) in Chronic Liver Disease

Background: The efficacy of the two-dose hepatitis B virus (HBV) vaccine (Heplisav-B (R)) in patients with chronic liver disease (CLD) is unknown. Aims: To compare the immunogenicity achieved with Heplisav-B and the conventional three-dose vaccine (Engerix-B (R)) in patients with CLD, and to identify factors that predict seroconversion. Methods: We retrospectively identified all adults who completed Heplisav-B or Engerix-B regimens from August 1, 2015, to January 31, 2019. Post-vaccination immunity was assessed by quantitative HBV surface antibody (HBsAb) measurement. Results: We identified 166 patients (106 Engerix-B and 60 Heplisav-B) with chronic liver disease (mean age 59.0 +/- 11.3 years, 52% male, 34% cirrhosis, mean MELD score of those with cirrhosis 10.1 +/- 5.4) who had completed the vaccinations and had data available on post-vaccination HBsAb levels at least 2 months after completion of the vaccine regimen. Seroprotective HBsAb levels (> 10 mIU/ml) were achieved in 63% with Heplisav-B and in 45% with Engerix-B (p = 0.03). Univariable analysis showed that age (p = 0.01), insurance (p = 0.02), renal failure (p = 0.02), COPD (p = 0.05), and cirrhosis (p < 0.01) had a significant effect on achieving immunogenicity. On multivariable analysis, patients with cirrhosis (adjusted odds ratio [aOR]: 0.27, 95% CI 0.13-0.55), COPD (aOR: 0.06, 95% CI 0.01-0.56), or renal failure (aOR 0.36, 95% CI 0.14-0.93) had a lower likelihood of achieving immunity, and patients who received Heplisav-B(R)had a 2.7-fold greater likelihood of achieving immunity than those who received Engerix-B(R)(aOR: 2.74, 95% CI 1.31-5.71). Conclusion: The two-dose recombinant hepatitis B vaccine resulted in better seroconversion than the three-dose vaccine. Cirrhosis, COPD, and renal failure were associated with a lower likelihood of achieving immunogenicity.