Conversion from intramuscular (IM) to subcutaneous administration (SC) of Hepatitis B immunoglobuline (HBIg) in liver transplant recipients: effect on quality of life (QoL).
L.C. Elshove, P.J. Far, B. Hansen, H.J. Metselaar, R.A. de Man
Moderator(s): H.J. Metselaar en M. Warlé
Location(s): Grote zaal
Category:
Background: Hepatitis B re-infection after liver transplantation (LTx) is prevented with a combination of oral nucleotide analogues and high dose intravenous HBIg during the first 3 months and replaced by monthly IM HBIg. However, IM injection is demanding and gives discomfort to the patient. A recent approved SC HBIg formulation (Zutectra®) can be self-administered by patients.
Aim of study To improve quality of life and patient satisfaction by switching IM to SC HBIg, maintaining anti-HBs level > 100 IU/L and prevent re-infection. .
Methods A single centre prospective study in 45 patients after LTx on IM HBIg. Patients were converted to SC HBIg weekly, according to manufacturers instruction. Patients were instructed to inject SC HBIg and followed for 1 year. QoL questionnaires, satisfaction, pain scores and adverse events were recorded at baseline, 1, 6 and 12 months. The results were analysed with SPSS.
Results Between October 2011 and August 2012, 34 male and 11 female patients with a median time after LTx of 7 years were converted to weekly SC HBIg. The already good QoL at baseline did not improve significantly during the study period. Mean pain score at baseline was 2,35. At 1 year 17 patients had equal pain score, 28 had an improved pain score (difference not significant). All patients maintained stable graft function without Hepatitis B re-infection. Mean anti-HBs level at baseline was 35 IE/L and increased to level ≥ 100 IE/L after 3 weeks and at 1 year the anti-HBs level was 187 IE/L (p=0,00). 44 Patients preferred the SC injections with a higher sense of autonomy and less inconvenience. The costs of SC HBIg during 1 year were significantly higher as compared to IM administration ( 11.129,80 versus 3265,36 euro). No severe adverse events were documented.
Conclusion Switching from monthly IM to weekly SC HBig is safe, with significantly higher anti-HBs levels. It improves patients satisfaction and gives a better sense of autonomy. However, the costs of SC HBIg are 4 times higher. Additional studies with lower frequency of SC injections are needed to demonstrate equal efficacy with reduced costs.