Aim To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations.
Methods An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018).
Results While most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved.
Conclusion Evidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.
- autoimmune diseases
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
CR and VF contributed equally.
Contributors CR, in collaboration with SvA, reviewed articles on efficacy, immunogenicity and safety of vaccination for influenza, hepatitis A, hepatitis B, tetanus toxoid, herpes zoster, yellow fever and tickborne encephalitis in patients with AIIRD, and drafted the first version of the manuscript. VF, in collaboration with OE, performed the literature search and reviewed articles on vaccination in patients with AIIRD on the various immunomodulating therapies. MH reviewed articles on efficacy, immunogenicity and safety of vaccination of human papillomavirus vaccination in patients with AIIRD. OE initiated the project, reviewed articles on efficacy, immunogenicity and safety of vaccination for pneumococcal disease in patients with AIIRD, and wrote the paragraphs on pneumococcal vaccination. All authors collaborated in discussions during two meetings, and read and approved the final manuscript.
Funding This project was supported by EULAR.
Competing interests KW reports personal fees from Pfizer, during the conduct of the study; grants and personal fees from Biotest, CSL Behring, personal fees from LFB, Grifols, Baxter, Roche, Octapharma, grants from BMS, outside the submitted work. AM reports grants and personal fees from ABBVIE, Pfizer, BMS, UCB, MERCK, during the conduct of the study. MD reports grants and personal fees from PFIZER, ABBVIE, UCB, NOVARTIS, LILLY, MERCK, ROCHE, grants from BMS, outside the submitted work. OE reports grants and personal fees from Pfizer, Abbvie, Roche, Janssen, personal fees from Novartis and Lilly. All other authors have no conflicts of interests to declare.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.