Data

Immunogenicity Data of Pneumococcal Vaccines in Patients With Rheumatologic Diseases

There is paucity of data regarding the effectiveness of pneumococcal vaccinations in patients with AIRD who are undergoing immunosuppressive therapy.¹ In a prospective, multicentre, double-blind, randomised, placebo-controlled trial, the effectiveness of PPSV23 in 900 patients with RA was evaluated across different Japanese hospitals. No difference in the rates of pneumonia were observed between the 2 study groups, which indicated that PPSV23 does not prevent against pneumonia overall in patients with RA.² A study compared the immunogenicity response of PCV13 in patients with RA with or without DMARDs. The study reported that the immunogenicity of PCV13 is not impaired in patients with RA who are not treated with a DMARD, and recommended that PCV13 should be used in patients with RA before the initiation of a DMARD.³ A long-term extension trial substudy revealed that around two-third of patients with RA on long-term baricitinib treatment achieved satisfactory immune response to PCV13, and that in patients taking concomitant corticosteroids, the response to PCV13 was not diminished.⁴ Another study found that vaccination with PCV13 was well tolerated and effective in patients with RA who were treated with etanercept.⁵

A recent study evaluated the antibody response of a prime boost strategy (single doses of PCV13 and PPSV23), as compared with a single PCV13 in patients with inflammatory rheumatic diseases. The patient either received treatment with different immunosuppressive drugs or controls. The study revealed that as compared with single pneumococcal vaccine, prime boost vaccination is more immunogenic in patients treated with DMARD or abatacept, but not in patients treated with rituximab. Therefore, pneumococcal vaccination should be encouraged prior to rituximab therapy initiation.⁶

A cross-sectional study assessed the vaccination coverage for PCV13 and PPSV23 in rheumatology patients on biological treatment. The vaccination coverage for PPSV23 was 77.9% and 80.2% for PCV13. The study concluded that pneumococcal vaccination had high coverage in these patients, and referring such patients to correct the immunisation would also help minimise a few of the infectious adverse effects of biological therapies.⁷

The impact of systemic sclerosis, a chronic inflammatory rheumatic disease, and DMARD treatment on the antibody response elicited by PCV13 or PPSV23, was evaluated in a study. The findings revealed that both PCV13 and PPSV23 yielded satisfactory antibody response in those patients who were not receiving DMARD treatment. However, a lower antibody response was elicited in patients with systemic sclerosis who were treated with synthetic DMARDs.⁸ Other rheumatic diseases include SLE, which is a systemic, autoimmune disease with heterogeneous clinical manifestations. A study explored the impact of SLE and belimumab given in addition to standard of care therapy, on the immunogenic response of these patients towards PCV13. The antibody response to PCV13 was not impaired even in those patients with SLE who were given belimumab in addition to a traditional DMARD.⁹

AIRD, autoimmune rheumatic disease; DMARD, disease-modifying antirheumatic drug; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal plain polysaccharide vaccine; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus.

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