Immune response to influenza A/H1N1 vaccine in inflammatory bowel disease patients treated with anti TNF-α agents: Effects of combined therapy with immunosuppressants

Andrisani, Gianluca; Frasca, Daniela; Romero, Maria; Armuzzi, Alessandro; Felice, Carla; Marzo, Manuela; Pugliese, Daniela; Papa, Alfredo; Mocci, Giammarco; Vitis, I. De; Rapaccini, Gian Ludovico; Blomberg, Bonnie B.; Guidi, L.

doi:10.1016/j.crohns.2012.05.011

Cited by 87 publications

(69 citation statements)

References 37 publications

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“…However, when patients are receiving immunosuppressive therapies with combined thiopurines and anti-TNF agents, serologic responses to vaccines are impaired ( 22,23,(43)(44)(45)(46)(47)(48)(49)(50)(51). Nonetheless, even a blunted vaccination response is thought to be of benefi t ( 52 ) and thus recommendations for infl uenza vaccination with inactivated vaccine continue to be broadly applicable to all patients, regardless of immunosuppression status ( 13,53 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

378

371

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

378

371

View full text Add to dashboard Cite

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“…Our findings of a reduced immune response in patients with IBD on immunomodulators are similar to previously published data with inactivated vaccines. 14, 15 Melmed et al 14 demonstrated a diminished response to the pneumococcal vaccine (PPSV23) in patients on combined antiTNFa and immunomodulator therapy. Another study evaluating the response to the influenza vaccine in IBD patients on either anti-TNFa monotherapy or combined therapy (anti-TNFa + immunomodulator) demonstrated a suboptimal response in the FIGURE 1.…”

Section: Discussionmentioning

confidence: 99%

Herpes Zoster Vaccine Response in Inflammatory Bowel Disease Patients on Low-dose Immunosuppression

Wasan

Zullow

Berg³

et al. 2016

Inflammatory Bowel Diseases

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“…A possible exception is the monovalent H1N1 vaccine administered during the 2009 epidemic. Andrisani, et al, found that IBD patients receiving anti TNF-␣ alone or combined with an immunomodulator, mounted a suboptimal immune response to influenza vaccine [23]. This was corroborated by Cullen et al, who found that only 36% of IBD subjects receiving combination immunosuppression were able to achieve seroprotection following the H1N1 vaccine [24].…”

Section: Discussionmentioning

confidence: 83%