Abstract
Objectives: Vaccination is a key strategy to reduce infection risk in RA patients and is advocated in internationally recognised rheumatology society guidelines. The aim was to evaluate to the impact of anti-rheumatic drugs on influenza and pneumococcal vaccine immunogenicity.
Methods: We conducted a systematic literature review and meta-analysis comparing the humoral response to influenza (pandemic and seasonal trivalent subunit
vaccines) and pneumococcal (PPV23, PCV-7, PCV-13) vaccination in adult RA patients treated with anti-rheumatic drugs. Vaccine immunogenicity was assessed by
seroprotection rates measured 3 to 6-weeks post immunisation. Risk ratios and 95% CIs were pooled.
Results: Nine studies were included in the meta-analysis (7 studies investigating anti-rheumatic drug exposures and influenza humoral response, 2 studies
investigating pneumococcal vaccine response). Influenza vaccine responses to all subunit strains (H1N1, H3N2, B strain) were preserved with methotrexate and TNF
inhibitor drug exposure. Methotrexate but not TNF inhibitor drug exposure was associated with reduced 6B and 23F serotype pneumococcal vaccine response (risk
ratio 0.42, 95% CI 0.28 to 0.63) vs. 0.98 (95% CI 0.58 to 1,67)), however limited data were available to draw any firm conclusions. Combination of methotrexate with
tocilizumab or tofacitinib was associated with reduced pneumococcal and influenza vaccine responses.
Conclusions: Anti-rheumatic drugs may negatively impact humoral responses to vaccination as evidenced by pneumococcal responses with methotrexate exposure,
however they are safe and should not preclude immunisation against vaccine preventable disease. Vaccination should be considered in all RA patients and
encouraged as part of routine care. Systematic review registration number: PROSPERO 2016: CRD42016048093.
Methods: We conducted a systematic literature review and meta-analysis comparing the humoral response to influenza (pandemic and seasonal trivalent subunit
vaccines) and pneumococcal (PPV23, PCV-7, PCV-13) vaccination in adult RA patients treated with anti-rheumatic drugs. Vaccine immunogenicity was assessed by
seroprotection rates measured 3 to 6-weeks post immunisation. Risk ratios and 95% CIs were pooled.
Results: Nine studies were included in the meta-analysis (7 studies investigating anti-rheumatic drug exposures and influenza humoral response, 2 studies
investigating pneumococcal vaccine response). Influenza vaccine responses to all subunit strains (H1N1, H3N2, B strain) were preserved with methotrexate and TNF
inhibitor drug exposure. Methotrexate but not TNF inhibitor drug exposure was associated with reduced 6B and 23F serotype pneumococcal vaccine response (risk
ratio 0.42, 95% CI 0.28 to 0.63) vs. 0.98 (95% CI 0.58 to 1,67)), however limited data were available to draw any firm conclusions. Combination of methotrexate with
tocilizumab or tofacitinib was associated with reduced pneumococcal and influenza vaccine responses.
Conclusions: Anti-rheumatic drugs may negatively impact humoral responses to vaccination as evidenced by pneumococcal responses with methotrexate exposure,
however they are safe and should not preclude immunisation against vaccine preventable disease. Vaccination should be considered in all RA patients and
encouraged as part of routine care. Systematic review registration number: PROSPERO 2016: CRD42016048093.
| Original language | English |
|---|---|
| Pages (from-to) | 733-744 |
| Journal | Journal of Rheumatology |
| Volume | 45 |
| Issue number | 6 |
| Early online date | 1 Jun 2018 |
| DOIs | |
| Publication status | Published - 1 Jun 2018 |
