High Immunogenicity to Influenza Vaccination in Crohn’s Disease Patients Treated with Ustekinumab

Abstract

Influenza vaccination can be less effective in patients treated with immunosuppressive therapy. However, little is known about the effects of ustekinumab; an anti-IL-12/23 agent used to treat Crohn’s disease (CD), on vaccination response. In this prospective study, we assessed immune responses to seasonal influenza vaccination in CD patients treated with ustekinumab compared to CD patients treated with anti-TNFα therapy (adalimumab) and healthy controls. Humoral responses were assessed with hemagglutinin inhibition (HI) assays. Influenza-specific total CD3+, CD3+CD4+, and CD3+CD8+ T-cell responses were measured with flow cytometry. Fifteen patients treated with ustekinumab; 12 with adalimumab and 20 healthy controls were vaccinated for seasonal influenza in September 2018. Seroprotection rates against all vaccine strains in the ustekinumab group were high and comparable to healthy controls. Seroconversion rates were comparable, and for A/H3N2 highest in the ustekinumab group. HI titers were significantly higher in the ustekinumab group and healthy controls than in the adalimumab group for the B/Victoria strain. Post-vaccination T-cell responses in the ustekinumab group were similar to healthy controls. One-month post-vaccination proliferation of CD3+CD8+ T-cells was highest in the ustekinumab group. In conclusion, ustekinumab does not impair immune responses to inactivated influenza vaccination. Therefore, CD patients treated with ustekinumab can be effectively vaccinated for seasonal influenza

SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting

“…Patients with rheumatoid arthritis on the JAK inhibitor tofacitinib mounted a normal antibody response against the influenza vaccine and a diminished response to the pneumococcal vaccine, which was not improved on temporary drug discontinuation. 38 IL12/23 blockade with ustekinumab does not seem to alter vaccine response to either the influenza 39 or pneumococcus vaccine 40 and may show higher antibody responses in the case of the HBV vaccine. 41 Similarly, patients with IBD treated with vedolizumab did not have altered immune responses to the influenza vaccine.…”

An evidence-based guide to SARS-CoV-2 vaccination of patients on immunotherapies in dermatology

“…155 This is further supported by a recent study showing decreased efficacy of influenza vaccination in patients treated with adalimumab but not ustekinumab. 156 In patients exposed to rituximab, most studies found a reduced humoral response to pneumococcal, 101,112,115,[126][127][128]135,157 hepatitis B, 136 and influenza vaccination. 73,108,111,116,122,130,142,144 Rituximab exposure did not significantly affect humoral response to seasonal influenza vaccination in patients with autoimmune blistering disease.…”

Safety and Efficacy of Vaccines during COVID-19 Pandemic in Patients Treated with Biological Drugs in a Dermatological Setting

“…Ustekinumab administration should be discontinued for at least 15 weeks before administering a live vaccine and may be resumed at least two weeks post-vaccination. Inactivated vaccines can be injected and several studies [ 44 , 45 ] demonstrated an effective immune response for pneumococcal polysaccharide, tetanus toxoid, and influenza vaccine. In the prospective study by Doornekamp et al [ 44 ], 15 patients with Crohn’s disease who were treated with ustekinumab and underwent influenza vaccination (Influvac) were evaluated, reporting an antibody response higher than that of healthy controls.…”

“…Inactivated vaccines can be injected and several studies [ 44 , 45 ] demonstrated an effective immune response for pneumococcal polysaccharide, tetanus toxoid, and influenza vaccine. In the prospective study by Doornekamp et al [ 44 ], 15 patients with Crohn’s disease who were treated with ustekinumab and underwent influenza vaccination (Influvac) were evaluated, reporting an antibody response higher than that of healthy controls. In the study by Brodmerkel et al [ 45 ], 60 patients on ustekinumab therapy for several years were vaccinated with both the 23-valent pneumococcal vaccine and tetanus toxoid, reporting superior antibody responses to untreated psoriatic patients.…”