Pneumococcal vaccine effective in RA, Sjögren's syndrome without DMARD treatment
Thirteen-valent pneumococcal conjugate vaccine is immunogenic among patients with rheumatoid arthritis and Sjögren’s syndrome who have not been treated with disease modifying anti-rheumatic drugs, according to findings published in BMC Rheumatology.
“The current recommendation for adults with immunocompromising conditions, is to receive immunization with a dose of [13-valent pneumococcal conjugate vaccine (PCV13)], followed in at least 8 weeks by a dose of [23-valent pneumococcal polysaccharide],” Per Nived, a PhD student at Lund University, Skåne University Hospital, and colleagues wrote. “RA and [primary Sjögren’s syndrome] are systemic autoimmune inflammatory diseases, but little is known whether the immunological disturbance as a part of disease itself influences the immune response to PCV13 vaccination since studies of the vaccine response in untreated RA and [ primary Sjögren’s syndrome] patients are scarce or non-existing.”
To determine whether the antibody response and functionality following PCV13 vaccination is lessened among patients with RA and primary Sjögren’s syndrome who had not received treatment with disease-modifying anti-rheumatic drugs (DMARD), the researchers recruited adult patients who had been regularly monitored at the Skåne University Hospital department of rheumatology. Among the participants, 60 had RA, of whom 50 had gone without DMARD treatment while 10 had been treated with methotrexate. In addition, 15 of the participants had primary Sjögren’s syndrome and had not received DMARD treatment. The researchers also recruited 49 healthy control participants from the department’s staff and their relatives. All participants received one dose of PCV13.
Nived and colleagues used enzyme-linked immunosorbent assay to determine serotype-specific antibody concentrations for pneumococcal serotypes 6B and 23F in serum, which had been collected before and 4 to 6 weeks after vaccination. In addition, they used opsonophagocytic activity assay to determine antibody functionality. Positive antibody response was defined as an at least twofold increase from prevaccination concentrations and an antibody response ratio of 2 or greater. Putative protective antibody level was defined as greater than 1.3 g/mL.
According to the researchers, antibody concentrations for both serotypes increased following vaccination among participants with RA who had not been treated with DMARD (P < .001), as well as those with primary Sjögren’s syndrome (P .05 and< .01) and the control population (P < .001). The proportion of patients with a positive antibody response among those with RA who had not been treated was 64% for 6B and 74% for 23F. Among patients with primary Sjögren’s syndrome, the rates for 67% for 6B and 53% for 23F, and for the control participants, they were 65% for 6B and 67% for 23F. For patients with RA who were treated with methotrexate, both rates were 20% (P < .01).
In addition, the researchers observed significant increases of patients reaching protective antibody levels in those with RA who had not been treated with DMARD (P .001), as well as those in the control group (P < .001). Opsonophagocytic activity assay increased significantly after vaccination among participants in the control group, those with RA without DMARD and those with primary Sjögren’s syndrome, but not among those who had been treated with methotrexate.
“Antigen challenge using pneumococcal conjugate vaccine in patients with RA or [primary Sjögren’s syndrome] without active anti-rheumatic treatment resulted in antibody response comparable to that of healthy controls,” Nived and colleagues wrote. “Similar to previous findings, a decreased response to this vaccine was observed in RA patients treated with methotrexate. These findings are in line with the previous recommendation that pneumococcal vaccination should be performed before initiation of [methotrexate].” – by Jason Laday
Disclosure: Nived reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.