Impaired long-term immune protection following pneumococcal 13-valent/23-valent polysaccharide vaccine in systemic lupus erythematosus (SLE)

Sacré, Karim; Goulenok, Tiphaine; Bahuaud, Mathilde; Francois, Chrystel; Haegen, Marie Claude Van der; Alexandra, Jean-François; Aucouturier, Pièrre; Hurtado-Nedelec, Maria; Batteux, Frédéric; Papo, Thomas

doi:10.1136/annrheumdis-2017-212789

Cited by 20 publications

(29 citation statements)

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“…Although SLE patients are at increased risk for Streptococcus pneumoniae infection (9, 11), vaccination coverage remains dramatically low (32). Limited data are available regarding efficacy of recommended prime-and-boost strategy using Prevnar-13 in SLE patients, but available evidence indicates that they can generate an effective response, albeit inferior compared to healthy controls (11, 33). Our data in MRL- lpr mice confirm that Prevnar-13 effectively promotes anti-pneumococcal response, even under MMF immunosuppression, supporting feasibility for vaccination use even in patients receiving immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Polysaccharide Vaccine Ameliorates Murine Lupus

et al. 2019

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Current guidelines encourage administering pneumococcal vaccine Prevnar-13 to patients with lupus, but whether such vaccinations affect disease severity is unclear. To address this issue, we treated 3-month-old MRL-lpr mice, that spontaneously develop a lupus-like syndrome, with Prevnar-13 or vehicle control. After 3 months, we quantified circulating anti-Pneumococcal polysaccharide capsule (PPS) antibodies and signs of disease severity, including albuminuria, renal histology and skin severity score. We also compared immunophenotypes and function of T and B cells from treated and untreated animals. Prevnar-13 elicited the formation of anti-pneumococcal IgM and IgG. Prevnar-13 treated animals showed reduced albuminuria, renal histological lesions, and milder dermatitis compared to vehicle-treated controls. Mitigated disease severity was associated with reduced and increased T follicular helper cells (TFH) and T follicular regulatory cells (TFR), respectively, in Prevnar-treated animals. T cells from Prevnar-13 vaccinated mice showed differential cytokine production after aCD3/aCD28 stimulation, with significantly decreased IL-17 and IL-4, and increased IL-10 production compared to non-vaccinated mice. In conclusion, pneumococcal vaccination elicits anti-pneumococcal antibody response and ameliorates disease severity in MRL-lpr mice, which associates with fewer TFH and increased TFR. Together, the data support use of Prevnar vaccination in individuals with SLE.

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Section: Discussionmentioning

confidence: 99%

Pneumococcal Polysaccharide Vaccine Ameliorates Murine Lupus

et al. 2019

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“…While previous literature on this topic is somewhat scant, in recent years a few studies have evaluated this question. Most recently, Sacre et al., 15 who evaluated 21 adults with sequential 13 - and 23-valent vaccination, demonstrated that slightly over half of their cohort maintained immunity to seven serotypes found in both vaccines at 12 months, and that patients with “B-cell defects” did not respond to vaccination. Grabar et al.…”

Section: Discussionmentioning

confidence: 99%

“…Comparison studies are of similar size. 11,15 Since the study was not blinded, selection bias in the study is possible due to physicians ensuring that patients who previously demonstrate poor response to vaccination are followed more closely for evidence of infection. Using a retrospective normal control group from immunology clinics in our and other hospitals, we see that virtually all normal healthy controls achieve protection, and the number of serotypes protected against is very high (95%).…”

Section: Discussionmentioning

confidence: 99%

“…These studies have been inconsistent in demonstrating production of sufficient anti-pneumococcal antibody in patients with SLE. 10–15 In addition, studies in other immunocompromised populations show inconsistent responses to sequential conjugated and unconjugated vaccination, with, for instance, patients with HIV demonstrating improved responses after sequential vaccination, 16 but patients with renal transplant and an adult cohort with SLE demonstrating generally sub-optimal antibody responses regardless of sequential vaccination. 11,17…”

Section: Introductionmentioning

confidence: 99%

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Immunogenicity of sequential 13-valent conjugated and 23-valent unconjugated pneumococcal vaccines in a population of children with lupus

Gorelik

Elizalde

Williams

et al. 2018

Lupus

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Pneumococcal vaccination is recommended as a quality indicator for management of children with systemic lupus erythematosus. Literature on the immunogenicity of pneumococcal vaccines (PCVs) in children is scant. We sought to prospectively evaluate via an observational study, the immunogenicity to sequential children with lupus. Out of a cohort of 26 patients, approximately 65% achieved > 70% vaccinated serotype antibody levels of > 1.3 mcg/dL following PCV13, and of 22 patients followed through PPSV23 vaccination, 59% achieved the same. Patients with rituximab exposure in the 6 months prior to a vaccination were more likely to not achieve protective serotype levels (p < 0.01 for PCV13, trend p = 0.07 for PPSV23). Three of 22 patients with no apparent risk factors did not achieve protective serotype levels. Non-responders to PCV13 generally did not respond to PPSV23. Retrospective healthy controls achieved 100% protective levels in response to PPSV23 vaccination, with 95% of serotypes being > 1.3 mcg/dL. Thus, sequential 13- and 23-valent pneumococcal vaccines achieve protective status for approximately two thirds of pediatric lupus patients in our population. Lack of response to vaccine may be secondary to induced or inherent functional impairments in the patient.

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“…With regard to anti-pneumococcal agents in SLE, several epidemiological studies have been conducted to assess their safety and efficacy with the reporting of inconsistent findings. Indeed, various studies found poor and impaired responses in terms of antibody titers, mainly for long-term immune protection following pneumococcal immunization in SLE patients (22)(23)(24), whereas others found anti-pneumococcal vaccines to be immunogenic with up to 79.2% having relevant protective antibody titres (25,26). Furthermore, the safety of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients.…”

Section: Introductionmentioning

confidence: 99%