Human hepatitis B immunoglobulins: Standardisation issues
https://doi.org/10.30895/2221-996X-2025-621
Abstract
INTRODUCTION. Human hepatitis B immunoglobulins (HBIGs) are produced from the plasma of vaccinated donors and are used to prevent hepatitis B virus infection. The main challenge associated with the quality control and efficacy evaluation of HBIGs is the lack of reference standards certified for the content of antibodies to hepatitis B virus surface antigen (HBsAg). Systematisation and analysis of the relevant experience in HBIG testing and manufacturing will contribute to the development of new approaches to HBIG standardisation.
AIM. This study aimed to characterise HBIGs and consider approaches to their standardisation.
DISCUSSION. Most HBIGs are developed in Germany (27%), Italy (17%), and the USA (17%) and are formulated for intramuscular (67%), intravenous (30%), and subcutaneous (3%) administration. The potency of HBIGs varies from 50 to 500 IU/mL. There are 3 HBIGs approved in Russia, but the available HBIGs do not fully cover the needs of prevention and treatment providers. The effectiveness of hepatitis B prevention directly depends on the HBIG dose, which is calculated using the potency of the HBIG. Ensuring the accuracy of HBIG potency determination requires a reference standard for anti-HBsAg antibodies certified in international units. The existing international standard for HBIGs has limited commercial availability in the Russian Federation, and the national (pharmacopoeial) reference standard for HBIGs is lacking.
CONCLUSIONS. The analysis of information on the currently manufactured HBIGs has identified recent development trends in this pharmaceutical industry sector. The future development and implementation of the national (pharmacopoeial) reference standard for anti-HBsAg antibodies will contribute to improving the quality of HBIGs and, therefore, the effectiveness of preventive immunisation against hepatitis B.
Keywords
About the Authors
E. A. KonovalovaRussian Federation
Ekaterina A. Konovalova
72 Krasnoarmeyskaya St., Kirov 610027
E. N. Kalinina
Russian Federation
Elena N. Kalinina
72 Krasnoarmeyskaya St., Kirov 610027
E. S. Kormshchikova
Russian Federation
Elena S. Kormshchikova, Сand. Sci. (Biol.)
72 Krasnoarmeyskaya St., Kirov 610027
E. V. Rosina
Russian Federation
Elena V. Rosina
72 Krasnoarmeyskaya St., Kirov 610027
S. E. Ziganshina
Russian Federation
Svetlana E. Ziganshina
72 Krasnoarmeyskaya St., Kirov 610027
K. A. Vorobiev
Russian Federation
Konstantin A. Vorobiev, Dr. Sci. (Biol.)
72 Krasnoarmeyskaya St., Kirov 610027
I. V. Paramonov
Russian Federation
Igor V. Paramonov, Dr. Sci. (Med.)
72 Krasnoarmeyskaya St., Kirov 610027
References
1. Ozeretskovsky NA, Shalunova NV, Petruchuk EM, Indikova IN. Vaccinal prevention of hepatitis B. Epidemiology and Vaccinal Prevention. 2015;14(2):87–95 (In Russ.). https://doi.org/10.31631/2073-3046-2015-14-2-87-95
2. Wei KP, Zhu FC, Liu JX, Yan L, Lu Y, Zhai XJ, et al. The efficacy of two different dosages of hepatitis B immunoglobulin combined with hepatitis B vaccine in preventing mother-to-child transmission of hepatitis B virus: A prospective cohort study. Vaccine. 2018;36(2):256–63. https://doi.org/10.1016/j.vaccine.2017.11.037
3. Zhou M, Li L, Han L, Sun F, Yi N. Breast-feeding is not a risk factor of mother-to-child transmission of hepatitis B virus. Int J Gen Med. 2021;14:1819–27. https://doi.org/10.2147/IJGM.S289804
4. Ruleva AA, Kharit SM. Vaccination of premature newborns. Journal Infectology. 2023;15(4):25–34 (In Russ.). https://doi.org/10.22625/2072-6732-2023-15-4-25-34
5. Shabunin AV, Smetanina SV, Drozdov PA. Results of using a multidisciplinary approach in the treatment of patients with liver cirrhosis as a result of chronic viral hepatitis. Effective Pharmacotherapy. 2022;18(22):20–24 (In Russ.). https://doi.org/10.33978/2307-3586-2022-18-22-20-24
6. Zuckerman JN. Review: Hepatitis B immune globulin for prevention of hepatitis B infection. J Med Virol. 2007;79(7):919–21. https://doi.org/10.1002/jmv.20816
7. Franco E, Bagnato B, Marino MG, Meleleo C, Serino L, Zaratti L. Hepatitis B: Epidemiology and prevention in developing countries. World J Hepatol. 2012;4(3):74–80. https://doi.org/10.4254/wjh.v4.i3.74
8. Moradi A, Zhand S, Ghaemi A, Javid N, Tabarraei A. Mutations in the S gene region of hepatitis B virus genotype D in Golestan Province–Iran. Virus Genes. 2012;44(3):382–7. https://doi.org/10.1007/s11262-012-0715-z
9. Gao Y, Zhang TY, Yuan Q, Xia NS. Antibody-mediated immunotherapy against chronic hepatitis B virus infection. Hum Vaccin Immunother. 2017;13(8):1768–73. https://doi.org/10.1080/21645515.2017.1319021
10. Schilling R, Ijaz S, Davidoff M, Lee JY, Locarnini S, Williams R, Naoumov NV. Endocytosis of hepatitis B immune globulin into hepatocytes inhibits the secretion of hepatitis B virus surface antigen and virions. J Virol. 2003;77(16):8882–92. https://doi.org/10.1128/jvi.77.16.8882-8892.2003
11. Das S, Ramakrishnan K, Behera SK. Hepatitis B vaccine and immunoglobulin: Key concepts. Clin Transl Hepatol. 2019; 7(2):165–71. https://doi.org/10.14218/JCTH.2018.00037
12. World Health Organisation. Hepatitis B vaccines: WHO position paper, July 2017 — Recommendations. Vaccine. 2019; 37(2):223–5. https://doi.org/10.1016/j.vaccine.2017.07.046
13. Akarsu M, Onem S, Turan I, Adali G, Akdogan M, Akyildiz M, et al. Recommendations for hepatitis B immunoglobulin and antiviral prophylaxis against hepatitis B recurrence after liver transplantation. Turk J Gastroenterol. 2021;32(9):712–9. https://doi.org/10.5152/tjg.2021.21608
14. Lee WC, Chou HS, Wu TH, Cheng CH, Lee CF, Wang YC, et al. Low-dose anti-hepatitis B immunoglobulin regimen as prophylaxis for hepatitis B recurrence after liver transplantation. Transpl Infect Dis. 2019;21(6):e13190. https://doi.org/10.1111/tid.13190
15. Kaptilnyy VA, Reyshtat DYu, Berishvili MV, Zholobova MN. Hepatitis B and C during pregnancy. V.F. Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):121–31 (In Russ.). https://doi.org/10.17816/2313-8726-2021-8-3-121-131
16. Habib S, Shaikh OS. Hepatitis B immune globulin. Drugs Today (Barc). 2007;43(6):379–94. https://doi.org/10.1358/dot.2007.43.6.1050792
17. Petrov VF, Nikolaeva AM, Kaz’janin AV, Parkhomenko TG, Borisova VN, Mel’nikov VA, Budanov MV. Antiviral preparation and method of preparing immunoglobulin for prophylaxis and treatment of patient with viral diseases. Patent of the Russian Federation No. 2144379; 2000 (In Russ.). EDN: PYWECF
18. Kudasheva EYu, Borisevich IV, Bondarev VP, Mironov AN. Technological aspects of ensuring viral safety of human immunoglobulin preparations. Medical Immunology. 2015;17:270–1 (In Russ.). EDN: UQDDVV
19. Furuta RA, Yasui T, Minamitani T, Akiba H, Toyoda C, Tobita R, et al. Development of a recombinant hepatitis B immunoglobulin derived from B cells collected from healthy individuals administered with hepatitis B virus vaccines: A feasibility study. Transfusion. 2023;63(6):1204–14. https://doi.org/10.1111/trf.17382
20. Krüger M. European hepatitis B immunoglobulin trials: Prevention of recurrent hepatitis B after liver transplantation. Clin Transplant. 2000;14(2):14–9. PMID: 10965959
21. Shouval D, Samuel D. Hepatitis B immuneglobulin to prevent hepatitis B virus graft reinfection following liver transplantation: A concise review. Hepatology. 2000;32(6):1189–95. https://doi.org/10.1053/jhep.2000.19789
22. Yan ML, Yan LN, Li B, Zeng Y, Wen TF, Wang WT, et al. Intramuscular hepatitis B immune globulin combined with lamivudine in prevention of hepatitis B recurrence after liver transplantation. Hepatobiliary Pancreat Dis Int. 2006;5(3):360–3. PMID: 16911931
23. Angus PW, Patterson SJ. Liver transplantation for hepatitis B: What is the best hepatitis B immune globulin/antiviral regimen? Liver Transpl. 2008;14(2):S15–22. https://doi.org/10.1002/lt.21614
24. Filipponi F, Franchello A, Carrai P, Romagnoli R, De Simone P, Woodward MK, et al. Efficacy, safety, and pharmacokinetics of intramuscular hepatitis B immune globulin, Igantibe, for the prophylaxis of viral B hepatitis after liver transplantation. Dig Liver Dis. 2010;42(7):509–14. https://doi.org/10.1016/j.dld.2009.09.005
25. Selcuk H, Karakayali H, Haberal M. Liver transplant and chronic hepatitis B virus infection. Exp Clin Transplant. 2011;9(2):94–7. PMID: 21453226
26. De Simone P, Romagnoli R, Tandoi F, Carrai P, Ercolani G, Peri E, et al. Early introduction of subcutaneous hepatitis B immunoglobulin following liver transplantation for hepatitis B virus infection: A prospective, multicenter study. Transplantation. 2016;100(7):1507–12. https://doi.org/10.1097/TP.0000000000001171
27. Park JS, Gayam V, Pan CQ. Review article: Preventing hepatitis B graft infection in hepatitis B patients after liver transplantation: immunoglobulin vs anti-virals. Aliment Pharmacol Ther. 2020;52(6):944–54. https://doi.org/10.1111/apt.15999
28. Mast EE, Margolis HS, Fiore АE, Brink EW, Goldstein ST, Wang SA, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: Recommendation of the Advisory Committee on Immunization Practices (ACIP). Part I: Immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005;54(RR-16):1–31. PMID: 16371945
29. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: Recommendation of the Advisory Committee on Immunization Practices (ACIP). Part II: Immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1–33. PMID: 17159833
30. Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, Nelson NP. Prevention of hepatitis B Virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67(1):1–31. https://doi.org/10.15585/mmwr.rr6701a1
31. Garofoli GK. Updated vaccination and screening recommendations for hepatitis B: Implications for pharmacists. J Am Pharm Assoc. 2024;64(5):102150. https://doi.org/10.1016/j.japh.2024.102150
32. Veronese P, Dodi I, Esposito S, Indolfi G. Prevention of vertical transmission of hepatitis B virus infection. World J Gastroenterol. 2021;27(26):4182–93. https://doi.org/10.3748/wjg.v27.i26.4182
33. Wang H, Fang JW, Gu ZW, Song DJ, Chen Y, Chen GD, et al. Application of hepatitis B immunoglobulin in prevention of mother-to-child transmission of chronic hepatitis B in HBsAg- and HBeAg-positive mother. J Obstet Gynaecol. 2022;42(5): 877–82. https://doi.org/10.1080/01443615.2021.1946495
34. Zubkova I, Zhao Y, Cui Q, Kachko A, Gimie Y, Chabot S, et al. Assessing the impact of hepatitis B immune globulin (HBIG) on responses to hepatitis B vaccine during co-administration. Vaccine. 2023;41(4):955–64. https://doi.org/10.1016/j.vaccine.2022.12.055
35. You H, Wang F, Li T, Xu X, Sun Y, Nan Y, et al. Guidelines for the prevention and treatment of chronic hepatitis B (version 2022). J Clin Transl Hepatol. 2023;11(6):1425–42. https://doi.org/10.14218/JCTH.2023.00320
36. Kazyanin AV, Vedernikova NV, Vyaznikova TV, Plenkina SV. Studying the pharmacodynamics of anti-HBs in different regimens of administration of the drug ANTIHEP and hepatitis B vaccine in an experiment. In: Materials of the All-Russian Scientiffc Conference “Topical issues of vaccine and serum work in the XXI century”. Perm; 2003. P. 86–9 (In Russ.).
37. Kazyanin AV, Plenkina SV, Nikolaeva AM, Borisova VN, Vedernikova NV, Vashin AL. Evaluation of the reactogenicity of the domestic specific human immunoglobulin against hepatitis B ANTI-GEP and the combined BUBO-M vaccine during immunization of contact persons in foci. In: Materials of the All-Russian Scientiffc Conference “Topical issues of vaccine and serum work in the XXI century”. Perm; 2003. P. 122–5 (In Russ.).
38. Kazyanin AV, Plenkina SV, Feldblum IV, Borisova VN. Comparative assessment of various immunization schemes against hepatitis B in children in closed organized groups. Perm Medical Journal. 2004;(2):103–7 (In Russ.).
39. Vorobyova NN, Kazyanin AV, Borisova VN, Myshkina OK, Rysinskaya TK, Nikolaeva AM, Dedova OV. The effectiveness of specific immunoglobulin (Antihep) in acute viral hepatitis B. Epidemiology and Vaccinal Prevention. 2004;2(15):13–16 (In Russ.).
40. Borisova GN, Nikolaeva AM, Vorobyova NN, Kazyanin AV, Rysinskaya TN, Myshkina OK, Dedova OV. Method for the treatment of acute viral hepatitis B. Patent of the Russian Federation No. 2240824; 2003 (In Russ.). EDN: BQDTLP
41. Leontiev DA. The system of secondary reference standards in drug quality control laboratories. Bulletin of the Scientiffc Centre for Expert Evaluation of Medicinal Products. 2016;(1):50–5 (In Russ.). EDN: VSBDNX
42. Merkulov VA, Sakanyan EI, Volkova RA, Klimov VI, Shemeryankina TB, Yashkir VA. Pharmacopeia standard samples and their practical application in the national drug standardization system. Pharm Chem J. 2016;50(4):258–61. https://doi.org/10.1007/s11094-016-1433-y
43. Borisevich IV, Kudasheva EYu, Perelygina OV, Mironov AN, Merkulov VA, Bondarev VP, et al. The state of the problem of standardization of specific immunoglobulins and antitoxic serums. Medical Immunology. 2015;17(S):379 (In Russ.). EDN: UQDDMF
44. Volkova RA, Fadeikina OV, Ustinnikova OB, Sarkisyan KA, Movsesyants AA, Merkulov VA, Kosenko VV. Requirements for the information on reference standards submitted in the dossier for biologicals. Biological Products. Prevention, Diagnosis, Treatment. 2024;24(1):7–20 (In Russ.). https://doi.org/10.30895/2221-996X-2024-24-1-7-20
45. Ferguson M, Yu MW, Heath A. Calibration of the second International Standard for hepatitis B immunoglobulin in an international collaborative study. Vox Sang. 2010;99(1):77–84. https://doi.org/10.1111/j.1423-0410.2010.01314.x
46. Volkova RA, Fadeikina OV, Klimov VI, Sakanyan EI, Olefir YuV, Merkulov VA., et al. Topical issues related to reference standards in the sphere of circulation of biological products. BIOpreparations. Prevention, Diagnosis, Treatment. 2016;16(4):229–36 (In Russ.). EDN: XEHMCB
47. Konovalova EA, Kormschikova ES. Standardization of human immunoglobulin drugs against hepatitis B according to the quality indicator “Specific activity” (literature review). In: Materials of the XIV All-Russian Scientiffc Conference “Young pharmacy — potential of the future”. St. Petersburg: SPHFU; 2024. Р. 624–7 (In Russ.).
48. Konovalova EA, Kalinina EN, Rosina EV, Ziganshina CE, Kormschikova ES. Search for potential donors of immuno-specific plasma containing antibodies to the surface antigen of the hepatitis B virus. In: Materials of the XIV All-Russian Scientiffc Conference “Young pharmacy — potential of the future”. St. Petersburg: SPHFU; 2024. Р. 47–8 (In Russ.).
49. Konovalova EA, Rosina EV, Kalinina EN, Ziganshina SE, Pivoshenko YaD, Kormschikova ES. Obtaining candidates reference standard of human immunoglobulin against hepatitis B. In: Materials of the Scientiffc and Practical Conference of young scientists and specialists “Current issues of transfusiology and oncohematology”. Kirov; 2024. P. 43–52 (In Russ.). EDN: LNORWG
Supplementary files
Review
For citations:
Konovalova E.A., Kalinina E.N., Kormshchikova E.S., Rosina E.V., Ziganshina S.E., Vorobiev K.A., Paramonov I.V. Human hepatitis B immunoglobulins: Standardisation issues. Biological Products. Prevention, Diagnosis, Treatment. 2025;25(2):170-181. (In Russ.) https://doi.org/10.30895/2221-996X-2025-621