Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tacrolimus

Abstract

IntroductionIn rheumatoid arthritis (RA) patients receiving immunosuppressive treatments, vaccination against Streptococcus pneumoniae is recommended. The objective of the study was to evaluate the effects of tacrolimus (TAC) on immune response following administration of a 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients with established RA.MethodsPatients with RA (n = 133) were vaccinated with PPSV23. Patients were classified into TAC (n = 29), methotrexate (MTX) (n = 55), control (n = 35), and TAC/MTX (n = 14) treatment groups. We measured the concentrations of pneumococcal serotypes 6B and 23F by using an enzyme-linked immunosorbent assay and determined antibody functionality by using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI), before and 4 to 6 weeks after vaccination. A positive antibody response was defined as at least a twofold increase in the IgG concentration or as at least a 10-fold increase in the OI.ResultsIgG concentrations and OIs were significantly increased in all treatment groups after PPSV23 vaccination. The TAC treatment group appears to respond in a manner similar to that of the RA control group in terms of 6B and 23F serotype concentration and function. In contrast, the MTX group had the lowest immune response. Patients who received a combination of TAC and MTX (TAC/MTX) also had a diminished immune response compared with those who received TAC alone.ConclusionsTAC monotherapy does not appear to impair PPSV23 immunogenicity in patients with RA, whereas antibody production and function may be reduced when TAC is used with MTX. Thus, PPSV23 administration during ongoing TAC treatment should be encouraged for infection-prone TAC-treated patients with rheumatic diseases.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0662-x) contains supplementary material, which is available to authorized users.

The 23-valent pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis: a double-blinded, randomized, placebo-controlled trial

“…To our knowledge, this is the first RCT to evaluate this concern in patients with RA. We demonstrated previously that PPSV23 vaccination induced the serotype-specific IgG and functional opsonization index responses were not impaired even in RA patients receiving immunosuppressive treatments [11]. However, we were unable to show that PPSV23 was effective in the prevention of pneumonia overall or pneumococcal pneumonia.…”

“…Patients with clinically diagnosed RA were recruited in National Hospital Organization (NHO) hospitals throughout Japan (the trial was conducted in NHO 32 hospitals) from September 2010 to December 2012 [11]. The risk of infections was reported to be associated with their comorbidity and treatments in RA patients [12].…”

Impfen bei Immundefizienz

“…Es besteht für immunsupprimierte Personen kein erhöhtes Risiko bezüglich ei-ner unerwünschten Nebenwirkung durch die Impfung mit Totimpfstoffen [48]. Unter immunsuppressiver Therapie ist die Gabe von Totimpfstoffen jederzeit möglich.…”

Vaccination in rheumatology (the 2019 update of EULAR recommendations)

“…В ретроспективном исследовании, включавшем 152 больных РА, получавших МТ, показано, что среди не вакцинированных от пневмококковой инфекции пациентов риск развития пневмонии возрастал в 9,7 раза по сравнению с вакцинированными [36]. Высокая иммуногенность и безопасность ППВ-23 продемонстрирована при РА, СКВ и других ИВРЗ [37][38][39][40], в том числе в исследованиях, выполненных в ФБГНУ НИИР им. В.А.…”