Granulocyte macrophage colony-stimulating factor as an adjuvant for hepatitis B vaccination: A meta-analysis

The efficacy of granulocyte macrophage colony-stimulating factor (GM-CSF) to enhance the immune response to hepatitis B virus vaccine has been object of several reports. We searched for randomized controlled clinical trials comparing GM-CSF given concomitantly to hepatitis B virus vaccine to vaccine given alone or with placebo. Data on rates of seroconversion (anti-HBs titers > 10 IU/ml) from 13 studies (734 subjects) produced combined estimates that favored GNI-CSF as compared to controls: rate ratio after a single immunization was 1.54 [95% confidence interval (Cl), 1.04-2.27] and 1.20 (95% CL 1.02-1.42) at the end of the vaccination cycle. Using a logistic approach a significant dose/response effect of GM-CSF was seen. Moreover, in renal failure patients who have responded to the vaccine, GM-CSF increased anti-HBs titers. Our findings suggest that GM-CSF induced a significant effect in terms of response rate and achievement of an earlier seroconversion to the vaccine in the overall populations examined, in renal failure patients and in healthy individuals. (c) 2006 Published by Elsevier Ltd.