Abstract
Patients with different autoimmune inflammatory diseases (AIID) on biological therapy are at risk of pneumococcal disease. Adults with inflammatory arthropathies, connective tissue diseases, psoriasis, or inflammatory bowel disease on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included in this study. Patients completed a protocol combining the pneumococcal vaccines PCV13 and PPV23. Immune response against pneumococcal serotypes 1, 3, 7F, 14, 19A, and 19F were assessed evaluating functional antibodies by an opsonophagocytosis killing assay (OPKA). In this study, 182 patients with AIID completed the sequential vaccination protocol. Patients on etanercept tended to achieve OPKA titers against a larger number of serotypes than the rest of patients on other biological therapies, while adalimumab was associated to a lower number of serotypes with OPKA titers. Rituximab was not associated with a worse response when compared with the rest of biological agents. Not glucocorticoids, nor synthetic disease-modifying antirheumatic drugs, interfered with the immune response. OPKA titers against serotype 3 which is one of the most prevalent, was obtained in 44% of patients, increasing up to 58% in those on etanercept. Hence, almost 50% of patients on biological therapy achieved functional antibodies after the administration of a complete pneumococcal vaccination protocol.
Highlights
People with autoimmune inflammatory diseases (AIID) have an increased risk of invasive pneumococcal disease (IPD) and nonbacteremic pneumonia
A noninterventional, multicenter, cohort study was designed to evaluate the immune response to Streptococcus pneumoniae vaccination in patients with AIID attending the Rheumatology, Dermatology or Gastroenterology services of the four University hospitals (Infanta Sofia, Madrid, Spain; Infanta Leonor Madrid, Spain; El Tajo, Madrid, Spain and Infanta Cristina, Madrid, Spain) that participated in the study
PCV13against and PPV23, which study evaluates thethat presence functional antibodies the six moreare prevthe two vaccines recommended by different international organizations for immunizing alent pneumococcal serotypes that are in common between PCV13 and PPV23, which are patients with autoimmune diseases treated with biological agents [6,7]
Summary
People with autoimmune inflammatory diseases (AIID) have an increased risk of invasive pneumococcal disease (IPD) and nonbacteremic pneumonia. Pneumococcal vaccination reduces the severity of these infections and is associated to lower hospital admission rates, less visits to emergency units and reduced IPD rates in patients with autoimmune inflammatory rheumatic diseases (AIIRD) treated with anti TNF-α drugs [4]. Pneumococcal vaccination in adults with AIIRD was included in the first European League against Rheumatism (EULAR). Recommendations in 2011 [5], keeping this vaccine strategy in 2019 for patients with AIIRD receiving immunosuppressive treatment [6]. EULAR recommendations agree with the Advisory Committee on Immunization Practices (ACIP) guidelines, that encourage routine use of 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged ≥ 19 years with immunocompromising conditions (including those with diseases requiring treatment with immunosuppressive drugs), in addition to the 23-valent pneumococcal polysaccharide vaccine (PPV23) [7]. In Spain, the country where the present study was carried out, 18 different
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