14
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Aim

          To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations.

          Methods

          An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018).

          Results

          While most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved.

          Conclusion

          Evidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.

          Related collections

          Most cited references190

          • Record: found
          • Abstract: found
          • Article: not found

          2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

          To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial.

            To examine immunization responses in patients with rheumatoid arthritis (RA) treated with rituximab and to investigate the effects of rituximab-induced CD20+ B cell depletion on immune responses to tetanus toxoid (T cell-dependent antigen), pneumococcal polysaccharide (T cell-independent antigen), and keyhole limpet hemocyanin (KLH) (neoantigen) and on delayed-type hypersensitivity (DTH). In a controlled trial, we enrolled 103 patients with active RA receiving a stable dose of methotrexate (MTX). Tetanus toxoid, pneumococcal polysaccharide, and KLH vaccines as well as a Candida albicans skin test were administered to 1 group of patients receiving rituximab plus MTX (called rituximab-treated patients) for 36 weeks and to 1 group of patients receiving MTX alone for 12 weeks. The primary end point was the proportion of patients with a >or=4-fold rise in antitetanus IgG levels. Antitetanus, antipneumococcal, and anti-KLH serum IgG levels were measured prior to and 4 weeks following vaccine administration. The DTH response to C albicans was measured 2-3 days following placement. Responses to tetanus toxoid vaccine (>or=4-fold rise) were similar in both groups (39.1% of rituximab-treated patients and 42.3% of patients treated with MTX alone). The ability to maintain a positive DTH response to the C albicans skin test was comparable in both groups (77.4% of rituximab-treated patients and 70% of patients treated with MTX alone), showing no effect of rituximab treatment. Rituximab-treated patients had decreased responses to pneumococcal polysaccharide vaccine (57% of patients had a 2-fold rise in titer in response to >or=1 serotype, compared with 82% of patients treated with MTX alone) and to KLH vaccine (47% of patients had detectable anti-KLH IgG, compared with 93% of patients treated with MTX alone). Recall responses to the T cell-dependent protein antigen tetanus toxoid as well as DTH responses were preserved in rituximab-treated RA patients 24 weeks after treatment. Responses to neoantigen (KLH) and T cell-independent responses to pneumococcal vaccine were decreased, but many patients were able to mount responses. These data suggest that polysaccharide and primary immunizations should be administered prior to rituximab infusions to maximize responses.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Effect of methotrexate, anti-tumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis.

              To assess the current literature on the impact of rheumatoid arthritis (RA) treatments on the humoral response to pneumococcal and influenza vaccines. We systematically searched the literature for studies evaluating the immune response to vaccines in RA patients receiving methotrexate (MTX) and/or biologic agents. The efficacy of vaccination, assessed by the response rate based on increased antibody titers before and 3-6 weeks after vaccination, was extracted by one investigator and verified by another. In total, 12 studies were included. RA patients mainly received MTX, anti-tumor necrosis factor α (anti-TNFα), or rituximab (RTX). Influenza vaccination response was reduced for RTX (43 patients; pooled odds ratio [OR] 0.44 [95% confidence interval (95% CI) 0.17-1.12] for H1N1, OR 0.11 [95% CI 0.04-0.31] for H3N2, and OR 0.29 [95% CI 0.10-0.81] for B) but not for anti-TNFα (308 patients; OR 0.93 [95% CI 0.36-2.37] for H1N1, OR 0.79 [95% CI 0.34-1.83] for H3N2, and OR 0.79 [95% CI 0.37-1.70] for B). For MTX, results differed depending on the method of analysis (222 patients; OR 0.35 [95% CI 0.18-0.66] for at least 2 strains, ORs were close to 1.0 in the single strain analysis). Pneumococcal vaccination response was reduced for 139 patients receiving MTX compared with controls (OR 0.33 [95% CI 0.20-0.54] for serotype 6B and OR 0.58 [95% CI 0.36-0.94] for 23F) but not for anti-TNFα (258 patients; OR 0.96 [95% CI 0.57-1.59] for 6B and OR 1.20 [95% CI 0.57-2.54] for 23F). For RTX, the response was reduced (88 patients; OR 0.25 [95% CI 0.11-0.58] for 6B and OR 0.21 [95% CI 0.04-1.05] for 23F). MTX decreases humoral response to pneumococcal vaccination and may impair response to influenza vaccination. The immune response to both vaccines is reduced with RTX but not with anti-TNFα therapy in RA patients. Copyright © 2014 by the American College of Rheumatology.
                Bookmark

                Author and article information

                Journal
                RMD Open
                RMD Open
                rmdopen
                rmdopen
                RMD Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2056-5933
                2019
                9 September 2019
                : 5
                : 2
                : e001035
                Affiliations
                [1 ]departmentMedical microbiology and infection prevention , UMCG , Groningen, The Netherlands
                [2 ]departmentRheumatology and Clinical Immunology , UMCG , Groningen, The Netherlands
                [3 ]departmentRheumatology , Tel Aviv Sourasky Medical Center , Tel Aviv, Israel
                [4 ]departmentFaculty of Medicine , Tel Aviv University Sackler , Tel Aviv, Israel
                [5 ]departmentInternal Medicine and Allergology, Rheumatology and Clinical Immunology , UMC Utrecht , Utrecht, The Netherlands
                [6 ]departmentZabludowicz Center for Autoimmune Diseases , Sheba Medical Center , Tel Hashomer, Israel
                [7 ]departmentInternal Medicine , Martini Hospital , Groningen, The Netherlands
                [8 ]departmentDepartment of Rheumatology , Leiden University Medical Center , Leiden, The Netherlands
                [9 ]departmentDipartimento di Medicina Clinica e Molecolare , Sapienza University of Rome , Roma, Italy
                [10 ]departmentHopital Cochin, Rheumatology , Université Paris Descartes , Paris, France
                [11 ]departmentClinical epidemiology and biostatistics , PRES Sorbonne Paris- Cité , Paris, France
                [12 ]departmentDepartment of Clinical Sciences, Section for Rheumatology , Lund University, Lund and Skåne University Hospital , Lund, Sweden
                [13 ]departmentDepartment of Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht, The Netherlands
                [14 ]departmentRheumatology , Aarhus University Hospital , Aarhus, Denmark
                [15 ]departmentClinical Immunology & Rheumatology , Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
                [16 ]departmentRheumatology , Zuyderland Medical Centre , Sittard-Geleen - Heerlen, The Netherlands
                [17 ]departmentRheumatology and Clinical Immunology , Giessen University , Giessen, Germany
                [18 ]departmentDepartment of Thrombosis and Haemophilia , Guy's and Saint Thomas’ Hospitals NHS Trust , London, UK
                [19 ]departmentRheumatology , King Christian X's Hospital for Rheumatic Diseases in Gråsten , Graasten, Denmark
                [20 ]Patient Research Partner , Tel Aviv, Israel
                [21 ]Patient Research Partner , Elgin, Scotland
                [22 ]departmentCentre for Chronic Immunodeficiency , University Medical Centre Freiburg , Freiburg, Germany
                [23 ]departmentPediatric Rheumatology , Wilhelmina Kinderziekenhuis , Utrecht, The Netherlands
                [24 ]departmentInternal medicine (infectious diseases) , Treant Care Group , Hoogeveen, The Netherlands
                Author notes
                [Correspondence to ] Dr Christien Rondaan; c.rondaan@ 123456umcg.nl
                Author information
                http://orcid.org/0000-0002-4558-1270
                http://orcid.org/0000-0003-2246-1986
                Article
                rmdopen-2019-001035
                10.1136/rmdopen-2019-001035
                6744079
                31565247
                b0a9cd8d-bcc4-49f0-81e1-e19e4bdae5ba
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 20 June 2019
                : 01 August 2019
                : 06 August 2019
                Categories
                Autoimmunity
                1506
                Original article
                Custom metadata
                unlocked

                infections,vaccination,autoimmune diseases
                infections, vaccination, autoimmune diseases

                Comments

                Comment on this article