As demonstrated in a flow-diagram of the study (Fig. 1), 1 month after vaccination, four patients Target Selective Inhibitor Library molecular weight were excluded from the levamisole group and two were excluded from the placebo group because of either death or renal transplantation. One month after vaccination, 13 out of 16 (81%) patients in the levamisole group as compared with six out of 18 (33%) patients

in placebo group developed protective anti-tetanus IgG levels (relative risk = 2.44, 95% confidence interval = 1.21, 4.88, P = 0.005) (Fig. 2). From 1 to 6 months post-vaccination, one more patient in the levamisole group and two more patients in the placebo group were excluded because of renal transplantation. None of the excluded patients had protective anti-tetanus IgG levels at 1 month post-vaccination. Moreover, two patients from each group who were seropositive at 1 month post-vaccination became seronegative at 6 months. Therefore, at 6 months post-vaccination, 11 out of 15 (73%) patients in the levamisole group as compared with four out of 16 (25%) patients in the placebo group still had protective anti-tetanus IgG levels (relative risk = 2.93, 95% confidence interval = 1.19, 7.23, P = 0.007) (Fig. 2). While the mean serum levels of anti-tetanus IgG levels

were similar at baseline in the levamisole and placebo groups (0.031 ± 0.025 IU/mL vs 0.027 ± 0.021 IU/mL, P = 0.64), the mean serum levels of anti-tetanus IgG were significantly higher in the levamisole group at 1 month (1.45 ± 1.74 IU/mL vs 0.25 ± 0.36 IU/mL, P = 0.008) PLX4032 and at 6 months (0.61 ± 0.79 IU/mL vs 0.11 ± 0.18 IU/mL, P = 0.012) post-vaccination. Four patients (two from each group) who were seropositive at 1 month but became seronegative at 6 months were older and had lower serum levels of anti-tetanus IgG at 1 month as compared with patients who stayed seropositive from 1 to 6 months (11 in the levamisole and four in the placebo group) (61.3 ± 5.1 years vs 51.7 ± 15.2 years, P = 0.23; 0.58 ± 0.51 IU/mL vs 1.66 ± 1.66 IU/mL, P = 0.27). However, these differences did not reach statistical significance. Other measured factors such as BMI and serum albumin levels were similar between these two groups. In the levamisole group, two patients

developed mild leukopenia (with white blood cell counts of 940 and 1130 cells/mcL, respectively), one patient developed abdominal pain Carnitine palmitoyltransferase II and one patient developed nausea during 12 days of levamisole therapy. In the placebo group, two patients developed abdominal pain and one patient developed nausea during 12 days of placebo therapy. However, these symptoms were not severe enough to stop the treatment and were reversed after 12 days of levamisole or placebo therapy. Although there are studies that showed no enhancing effect of levamisole on haemodialysis patients’ response rates to HBV vaccination,[12] most studies demonstrate that levamisole has a beneficial effect.[8-10] In two recent meta-analyses by Fabrizi et al. and Alavian et al.