Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

Adawi, Mohammad; Bragazzi, Nicola Luigi; McGonagle, Dennis; Watad, Samaa; Mahroum, Naim; Damiani, Giovanni; Conic, Rosalynn R.Z.; Bridgewood, Charlie; Mahagna, Hussein; Giacomelli, Luca; Eggenhöffner, Roberto; Mahamid, Mahmud; Pigatto, Paolo D.; Amital, Howard; Watad, Abdulla

doi:10.1016/j.autrev.2018.08.002

Cited by 25 publications

(20 citation statements)

References 62 publications

(84 reference statements)

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“…A total of 32 systematic reviews focused on non-COVID-19 vaccines ( Table 3 ). Several vaccines were studied, including inactivated hepatitis A vaccine [ 32 ], recombinant hepatitis B vaccine [ 33 , 34 , 35 , 36 , 37 , 38 ], recombinant human papillomavirus vaccines [ 39 , 40 ], inactivated influenza vaccine [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], live-attenuated measles vaccine (given post hematopoietic stem-cell transplantation [ 52 ] and in children living with human immunodeficiency virus [ 53 ]), pneumococcal conjugate and polysaccharide vaccines [ 46 , 49 , 54 , 55 , 56 ], live-attenuated and recombinant subunit zoster vaccines [ 57 , 58 ], live-attenuated yellow fever vaccine [ 59 ], and others [ 60 , 61 , 62 , 63 ]. Immunocompromised states studied included use of B-cell-depleting anti-CD20 therapy, chronic kidney failure, human immunodeficiency virus infection, immune-mediated inflammatory diseases, liver cirrhosis, malignancy, post-splenectomy status, and solid organ transplant recipients.…”

Section: Resultsmentioning

confidence: 99%

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

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2022

Vaccines

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Vaccination is crucial for avoiding infection-associated morbidity and mortality among immunocompromised patients. However, immunocompromised patients respond less well to vaccinations compared to healthy people, and little is known about the relative efficacy of various vaccines among different immunocompromised states. A total of 54 systematic reviews (22 COVID-19; 32 non-COVID-19) published within the last 5 years in Pubmed® were reviewed. They demonstrated similar patterns within three seroconversion response categories: good (about >60% when compared to healthy controls), intermediate (~40–60%), and poor (about <40%). Good vaccine responses would be expected for patients with chronic kidney disease, human immunodeficiency virus infection (normal CD4 counts), immune-mediated inflammatory diseases, post-splenectomy states, and solid tumors. Intermediate vaccine responses would be expected for patients with anti-cytotoxic T-lymphocyte antigen-4 therapy, hematologic cancer, and human immunodeficiency virus infection (low CD4 counts). Poor vaccine responses would be expected for patients with B-cell-depleting agents (e.g., anti-CD20 therapy), hematopoietic stem-cell transplant, solid organ transplant, and liver cirrhosis. For all vaccine response categories, vaccination should be timed when patients are least immunosuppressed. For the intermediate and poor vaccine response categories, high-dose vaccine, revaccination when patients are less immunosuppressed, checking for seroconversion, additional booster doses, and long-acting monoclonal antibodies may be considered, supplemented by shielding measures.

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Section: Resultsmentioning

confidence: 99%

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

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2022

Vaccines

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“…49 Immunogenicity post vaccination with inactivated vaccines appears to depend on the dose and duration of prednisolone therapy. 50 A study of the influenza vaccine in patients with SLE showed a trend of reduced immunogenicity in patients taking prednisolone >10 mg daily (mean number of immune responses 1.14 vs 1.65), although this was not a significant difference. 51 Dosage related reduction in antibody response has also been observed with the pneumococcal vaccine.…”

Section: Prednisolonementioning

confidence: 98%

Lupus, vaccinations and COVID-19: What we know now

Mason

Anver

Lwin

et al. 2021

Lupus

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.

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“…No serious adverse events with pneumococcal vaccine were reported in a systematic review of studies in patients with systemic lupus erythematosus ( 119 ) or in 4 observational studies in patients with IBD ( 15 , 115–117 ).…”

Section: Inactivated Vaccines In Patients With Inflammatory Bowel Diseasementioning

confidence: 99%

Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

Jones

Tse

Carroll

et al. 2021

Journal of the Canadian Association of Gastroenterology

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Background and Aims The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. Methods Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. Results Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada’s National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27–45 years. Conclusions Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.

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Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

Abstract: This is a repository copy of Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis.

Cited by 25 publications

References 62 publications

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

Lupus, vaccinations and COVID-19: What we know now

Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

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