Effect of abatacept on the immunogenicity of 23-valent pneumococcal polysaccharide vaccination (PPSV23) in rheumatoid arthritis patients

Abstract

IntroductionPatients with rheumatoid arthritis (RA) treated with abatacept (ABT) are at increased risk for vaccine-preventable infections. The aim of the present study is to evaluate the humoral response to 23-valent pneumococcal polysaccharide (PPSV23) vaccination in RA patients receiving ABT.MethodsThe immunogenicity study was nested within a randomized, double-blind placebo-controlled study, designed to evaluate the efficacy of the PPSV23. PPSV23 was given to 111 RA patients, who were classified into three groups: RA control (n = 35), methotrexate (MTX) alone (n = 55), and ABT (n = 21). Before and 4–6 weeks after vaccination, we measured the patients’ concentrations of antibodies against pneumococcal serotypes 6B and 23F using an enzyme-linked immunosorbent assay and determined their antibody functionality using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI).ResultsThe pneumococcal serotype-specific IgG concentrations and OIs were both significantly increased in all treatment groups in response to PPSV23 vaccination. In the ABT group, the IgG responses for the 6B serotype were lower compared with those in the MTX alone or control groups, whereas the OI responses were similar to those in the other two groups. In a subgroup analysis, the pneumococcal serotype-specific IgG responses were significantly lower in both serotypes (6B and 23F) in the ABT/MTX group; however, the OI responses in the ABT group were not different from the control group. There was no association between the pneumococcal serotype-specific IgG and OI responses for the 6B serotype in patients receiving ABT in contrast to the control or MTX alone patients. No severe adverse effects were observed in any of the treatment groups.ConclusionsOI responses indicate antibody functionality rather than simply their amount, so the similarity of these measurements between all three groups suggests that RA patients receiving ABT still benefit from receiving the PPSV23 vaccination, even though they produce less IgG in response to it. The results suggest an influence of ABT on the humoral response to PPSV23 vaccination under MTX treatment; however, preserved opsonin responses are expected in RA patients treated with ABT plus MTX.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012.

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

“…Combination of abatacept and a conventional DMARD significantly reduced the response towards the 2009 influenza vaccine [101]. Similar data have been proposed for vaccination against pneumococcus pneumoniae [102,103].…”

A Systematic Review and Metaanalysis of Antirheumatic Drugs and Vaccine Immunogenicity in Rheumatoid Arthritis

“…There were limited data to perform meta-analysis on TOC exposure on vaccine responses compared to healthy controls, although review of the literature suggests there no significant effect on PPV or influenza vaccine immunogenicity, [18,24]. Comparatively, ABA has been reported to impair the responses to pH1N1 and PPV23 response, [16,23]. To our knowledge, there has been 1 previous meta-analysis assessing the influence of antirheumatic drug therapies on influenza and pneumococcal vaccine responses, [42].…”

“…The data on ABA exposure and humoral vaccine response are conflicting. Migita et al, [23] found significantly decreased Ab response rates for 6B and combined 6B/23F SR rates in ABA exposed patients compared to MTX and RA control groups. In contrast, Alten et al , [17] described preserved SP response to PPV23 vaccination with 55.4% of ABA exposed patients achieving adequate SP response to PPV23 vaccination.…”

The use of biological disease-modifying antirheumatic drugs for inflammatory arthritis in Korea: results of a Korean Expert Consensus

“…Given the high risk of infection in patients receiving biologic therapy, the 2015 ACR and APLAR guidelines recommended assessment of vaccination history and completion of outstanding vaccination when possible, before initiating bDMARDs. Several RCTs studied the safety and efficacy of pneumococcus, influenza, and HBV vaccination in patients receiving biologic therapy [133][134][135][136][137][138][139][140]. Biologic therapy seems to be unrelated to the side effect of the killed vaccine.…”