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      Granulocyte-Macrophage Colony-Stimulating Factor as an Adjuvant to Hepatitis B Vaccination in Maintenance Hemodialysis Patients

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          Abstract

          Patients on maintenance hemodialysis (HD) have poor seroconversion rate after hepatitis B vaccination. The present study was designed to test the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant to hepatitis B vaccination for improving seroconversion rate in maintenance HD patients. Twelve chronic HD patients were randomly assigned to receive either hepatitis B vaccination alone or hepatitis B vaccination 24 h after 1 dose of GM-CSF for primary immunization. A group of 16 chronic HD patients who had not seroconverted after a standard two-dose hepatitis B vaccination were randomly assigned either to a booster dose of hepatitis B vaccine alone or a booster dose given 24 h after one dose of GM-CSF. In the primary immunization group only 2 of 6 patients (33%) who had received vaccination alone, versus 5 of 6 patients (83%) who had received hepatitis B vaccine after one dose of GM-CSF, developed seroprotective antibody titers. Moreover, seroprotective antibody titers (IU/ml) were significantly higher in the latter group (275 ± 286.5 vs. 14 ± 22, p < 0.05). In patients who had not seroconverted with prior hepatitis B vaccination, GM-CSF adjuvant therapy significantly increased the seroconversion rate versus booster dose alone (87.5 vs. 25%, respectively, p < 0.02), with significantly higher seroprotective antibody titers (84 ± 80 vs. 19 ± 33 IU/ml, respectively, p < 0.05). These findings suggest that administration of one dose of GM-CSF, as adjuvant therapy, prior to primary or booster dose hepatitis B vaccination may significantly increase seroconversion rate and seroprotective antibody titers in chronic HD patients.

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          Most cited references 1

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          Duration of hepatitis B surface antigenemia (HBs Ag) in hemodialysis patients.

          Follow-up studies were done on 231 hemodialysis patients during a period of from one to 48 months to determine the natural history of hepatitis B surface antigenemia (HBs Ag). Of those studied, 113 (49%) exhibited HBs Ag. The probability of remaining HBs Ag positive over the mean follow-up period of 14.4 months was 62%. All of the 38 patients whose HBs Ag reverted to negative did so within ten months. Those patients whose HBs Ag reverted to negative had SGOT levels that were less frequently elevated than the patients with persistent antigenemia. Of hemodialysis patients with HBs Ag, 60% showed e antigen (HBe Ag).
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            Author and article information

            Journal
            AJN
            Am J Nephrol
            10.1159/issn.0250-8095
            American Journal of Nephrology
            S. Karger AG
            0250-8095
            1421-9670
            2000
            February 2000
            13 January 2000
            : 20
            : 1
            : 53-56
            Affiliations
            aDivision of Nephrology, Manipal Hospital, Bangalore, India; bDivision of Nephrology, Saint Louis University School of Medicine, St. Louis, Mo., USA
            Article
            13556 Am J Nephrol 2000;20:53–56
            10.1159/000013556
            10644869
            © 2000 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Tables: 2, References: 24, Pages: 4
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/13556
            Categories
            Clinical Study

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