Further Evidence for Influenza and Pneumococcal Vaccination in Patients Treated with Disease Modifying Antirheumatic Drugs and Anti-Tumor Necrosis Factor Agents

Abstract

Patients with rheumatoid arthritis (RA) have increased risk of infections including possible vaccine-preventable ones1,2,3,4,5,6,7. Susceptibility to infections is considered to be partly associated with RA itself, i.e., immunological alterations as a part of the disease, disease activity, and disability2,3. Antirheumatic treatment, in particular longterm use of glucocorticoids, but also traditional disease modifying antirheumatic drugs (DMARD) and biological remedies have all been shown to increase risk of infections4,5,6. In addition, higher age, concomitant smoking, common comorbidities such as chronic obstructive pulmonary disease, diabetes mellitus, kidney disease, or malignancies contribute to increased infection risk2,3,5. Vaccination is an appealing strategy in the attempt to reduce the burden of infectious diseases in RA. The recent European League Against Rheumatism (EULAR) recommendations, based on current evidence and expert opinion, recommend that rheumatologists strongly consider annual inactive influenza and pneumococcal vaccination for their patients with inflammatory rheumatic diseases7. Similarly, the US Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) recommends these vaccines to all subjects ≥ 65 years and those treated with immunosuppressive agents8. Thus, the majority of patients with RA should get annual seasonal influenza vaccine, and pneumococcal vaccine at least once in life. However, vaccine coverage among patients with RA, including those treated with anti-tumor necrosis factor (TNF) agents is still low7,8. There are a number of reasons for low influenza and pneumococcal vaccination rates. Anti-TNF treatments as first biologics for treatment of RA have been available for some 15 years, so data on safety, immunogenicity, and effectiveness of vaccines performed under treatment with these and other biologics are still limited. Prelicensure studies … Address correspondence to Dr. Kapetanovic, E-mail: meliha.c_kapetanovic{at}med.lu.se