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Persistence of antibody response 1.5 years after vaccination using 7-valent pneumococcal conjugate vaccine in patients with arthritis treated with different antirheumatic drugs.

Crnkic Kapetanovic M, Saxne T, Truedsson L, Geborek P - Arthritis Res. Ther. (2013)

Bottom Line: Higher prevaccination antibody levels for both serotypes 23F and 6B were associated with better persistence of protective antibodies (P<0.001).After initial increase, 1.5 years after pneumococcal vaccination with 7-valent conjugate vaccine, postvaccination antibody levels decreased significantly, reaching levels before vaccination in this cohort of patients with established arthritis treated with different antirheumatic drugs.EudraCT EU 2007-006539-29 and NCT00828997.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The aim of this study was to explore the persistence of an antibody response 1.5 years after vaccination with 7-valent pneumococcal conjugate vaccine in patients with rheumatoid arthritis (RA) or spondyloarthropathy (SpA) treated with different antirheumatic drugs.

Methods: Of 505 patients initially recruited, data on current antirheumatic treatment and blood samples were obtained from 398 (79%) subjects after mean (SD, range) 1.4 (0.5; 1 to 2) years. Antibody levels against pneumococcal serotypes 23F and 6B were analyzed by using enzyme-linked immunosorbent assay (ELISA). Original treatment groups were as follows: (a) RA receiving methotrexate (MTX); (b) RA taking anti-TNF monotherapy; (c) RA taking anti-TNF+MTX; (d) SpA with anti-TNF monotherapy; (e) SpA taking anti-TNF+MTX; and (f) SpA taking NSAID/analgesics. Geometric mean levels (GMLs; 95% CI) and proportion (percentage) of patients with putative protective antibody levels≥1 mg/L for both serotypes, calculated in different treatment groups, were compared with results 4 to 6 weeks after vaccination. Patients remaining on initial treatment were included in the analysis. Possible predictors of persistence of protective antibody response were analysed by using logistic regression analysis.

Results: Of 398 patients participating in the 1.5-year follow up, 302 patients (RA, 163, and SpA, 139) had unchanged medication. Compared with postvaccination levels at 1.5 years, GMLs for each serotype were significantly lower in all groups (P between 0.035 and <0.001; paired-sample t test), as were the proportions of patients with protective antibody levels for both serotypes (P<0.001; χ2 test). Higher prevaccination antibody levels for both serotypes 23F and 6B were associated with better persistence of protective antibodies (P<0.001). Compared with patients with protective antibody levels at 1.5 years, those not having protective antibody levels were older, more often women, had longer disease duration and higher HAQ and DAS, and had a lower proportion of initial responders to both serotypes.

Conclusions: After initial increase, 1.5 years after pneumococcal vaccination with 7-valent conjugate vaccine, postvaccination antibody levels decreased significantly, reaching levels before vaccination in this cohort of patients with established arthritis treated with different antirheumatic drugs. MTX and anti-TNF treatment predicted low persistence of protective immunity among patients with RA. To boost antibody response, early revaccination with conjugate vaccine might be needed in patients receiving potent immunosuppressive remedies.

Trial registration number: EudraCT EU 2007-006539-29 and NCT00828997.

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Percentage of patients with putative protective antibody levels (≥1 mg/L) for serotype 23 F 6B and both 23 F and 6 B (C) at vaccination, at 4 to 6 weeks after vaccination, and at 1.5-year follow-up in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) treated with different antiinflammatory drugs.
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Figure 3: Percentage of patients with putative protective antibody levels (≥1 mg/L) for serotype 23 F 6B and both 23 F and 6 B (C) at vaccination, at 4 to 6 weeks after vaccination, and at 1.5-year follow-up in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) treated with different antiinflammatory drugs.

Mentions: SpA patients taking NSAIDs/analgesics (that is, not treated with immunosuppressive remedies) had significantly higher proportions of patients with protective antibody levels both at 4 to 6 weeks and at 1.5 years of follow-up. Although the proportion of patients with protective antibody levels decreased in this group at 1.5-year follow-up, the relative ratio of protective antibody levels (that is, 1.5-year follow-up/4 to 6 weeks follow-up) was still highest in SpA patients with NSAIDs/analgesics. The lowest relative ratio of protective antibody levels was seen in RA patients taking anti-TNF+MTX and in general lower in RA patients than in patients with SpA. The proportions of patients with protective antibody levels for 23F, 6B, and both serotypes at vaccination, at 4 to 6 weeks after vaccination, and at 1.5-year follow-up in different treatment groups are shown in Figure 3.


Persistence of antibody response 1.5 years after vaccination using 7-valent pneumococcal conjugate vaccine in patients with arthritis treated with different antirheumatic drugs.

Crnkic Kapetanovic M, Saxne T, Truedsson L, Geborek P - Arthritis Res. Ther. (2013)

Percentage of patients with putative protective antibody levels (≥1 mg/L) for serotype 23 F 6B and both 23 F and 6 B (C) at vaccination, at 4 to 6 weeks after vaccination, and at 1.5-year follow-up in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) treated with different antiinflammatory drugs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672713&req=5

Figure 3: Percentage of patients with putative protective antibody levels (≥1 mg/L) for serotype 23 F 6B and both 23 F and 6 B (C) at vaccination, at 4 to 6 weeks after vaccination, and at 1.5-year follow-up in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) treated with different antiinflammatory drugs.
Mentions: SpA patients taking NSAIDs/analgesics (that is, not treated with immunosuppressive remedies) had significantly higher proportions of patients with protective antibody levels both at 4 to 6 weeks and at 1.5 years of follow-up. Although the proportion of patients with protective antibody levels decreased in this group at 1.5-year follow-up, the relative ratio of protective antibody levels (that is, 1.5-year follow-up/4 to 6 weeks follow-up) was still highest in SpA patients with NSAIDs/analgesics. The lowest relative ratio of protective antibody levels was seen in RA patients taking anti-TNF+MTX and in general lower in RA patients than in patients with SpA. The proportions of patients with protective antibody levels for 23F, 6B, and both serotypes at vaccination, at 4 to 6 weeks after vaccination, and at 1.5-year follow-up in different treatment groups are shown in Figure 3.

Bottom Line: Higher prevaccination antibody levels for both serotypes 23F and 6B were associated with better persistence of protective antibodies (P<0.001).After initial increase, 1.5 years after pneumococcal vaccination with 7-valent conjugate vaccine, postvaccination antibody levels decreased significantly, reaching levels before vaccination in this cohort of patients with established arthritis treated with different antirheumatic drugs.EudraCT EU 2007-006539-29 and NCT00828997.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The aim of this study was to explore the persistence of an antibody response 1.5 years after vaccination with 7-valent pneumococcal conjugate vaccine in patients with rheumatoid arthritis (RA) or spondyloarthropathy (SpA) treated with different antirheumatic drugs.

Methods: Of 505 patients initially recruited, data on current antirheumatic treatment and blood samples were obtained from 398 (79%) subjects after mean (SD, range) 1.4 (0.5; 1 to 2) years. Antibody levels against pneumococcal serotypes 23F and 6B were analyzed by using enzyme-linked immunosorbent assay (ELISA). Original treatment groups were as follows: (a) RA receiving methotrexate (MTX); (b) RA taking anti-TNF monotherapy; (c) RA taking anti-TNF+MTX; (d) SpA with anti-TNF monotherapy; (e) SpA taking anti-TNF+MTX; and (f) SpA taking NSAID/analgesics. Geometric mean levels (GMLs; 95% CI) and proportion (percentage) of patients with putative protective antibody levels≥1 mg/L for both serotypes, calculated in different treatment groups, were compared with results 4 to 6 weeks after vaccination. Patients remaining on initial treatment were included in the analysis. Possible predictors of persistence of protective antibody response were analysed by using logistic regression analysis.

Results: Of 398 patients participating in the 1.5-year follow up, 302 patients (RA, 163, and SpA, 139) had unchanged medication. Compared with postvaccination levels at 1.5 years, GMLs for each serotype were significantly lower in all groups (P between 0.035 and <0.001; paired-sample t test), as were the proportions of patients with protective antibody levels for both serotypes (P<0.001; χ2 test). Higher prevaccination antibody levels for both serotypes 23F and 6B were associated with better persistence of protective antibodies (P<0.001). Compared with patients with protective antibody levels at 1.5 years, those not having protective antibody levels were older, more often women, had longer disease duration and higher HAQ and DAS, and had a lower proportion of initial responders to both serotypes.

Conclusions: After initial increase, 1.5 years after pneumococcal vaccination with 7-valent conjugate vaccine, postvaccination antibody levels decreased significantly, reaching levels before vaccination in this cohort of patients with established arthritis treated with different antirheumatic drugs. MTX and anti-TNF treatment predicted low persistence of protective immunity among patients with RA. To boost antibody response, early revaccination with conjugate vaccine might be needed in patients receiving potent immunosuppressive remedies.

Trial registration number: EudraCT EU 2007-006539-29 and NCT00828997.

Show MeSH
Related in: MedlinePlus