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Heptavalent pneumococcal conjugate vaccine elicits similar antibody response as standard 23-valent polysaccharide vaccine in adult patients with RA treated with immunomodulating drugs

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Abstract

The objectives of the study were to compare antibody response in immunosuppressed patients with rheumatoid arthritis (RA) after vaccination with heptavalent pneumococcal conjugate vaccine (PCV7) to that of RA patients and healthy controls vaccinated with 23-valent polysaccharide vaccine (PPV23) and to study the impact of disease and/or treatment characteristics and type of vaccine on antibody response following pneumococcal vaccination in patients with RA. In total, 253 RA patients treated with methotrexate (MTX), anti-TNF blockers as monotherapy or anti-TNF + MTX were vaccinated with a single dose (0.5 ml) of PCV7. In addition, 149 RA patients receiving corresponding treatments and 47 healthy controls were vaccinated with a single dose (0.5 ml) of PPV23. Serotype-specific IgG to 23F and 6B were measured at vaccination and 4–6 weeks after vaccination using ELISA. Antibody response ratio (ARR), i.e. ratio between post-/prevaccination antibody levels, was compared between corresponding treatment groups. Differences in ARR were analysed using analysis of variance. Positive antibody response (posAR) was defined as equal to or greater than twofold increase in prevaccination antibody levels. Possible predictors of posAR were analysed using logistic regression model. Corresponding RA treatment groups showed similar ARR and posAR for both serotypes regardless of vaccine type. Higher age at vaccination and concomitant MTX were identified as predictors of impaired posAR for both serotypes tested, whereas type of vaccine did not influence posAR significantly. PCV7 elicits similar antibody response as PPV23 in patients with RA receiving immunosuppressive treatment. In RA patients, higher age and MTX treatment but not type of vaccine predicted impaired posAR.

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Acknowledgements

The authors wish to thank the late Lotta Larsson, Elna Haglund, Eva-Karin Kristoffersson, Helén Axelsson and Käthe Nilsson for their help with vaccination, collecting blood samples and carrying through the study; Peter Kapral, Maria Jacobsson, Ingrid Moberg, Ingrid Bondesson, Ingrid Hermansson and Eva Hommerberg, all from the Department for Rheumatology, Skåne Universitetssjukhus Lund and Malmö, for taking care of blood samples and Ingrid Mattsson-Geborek for skilful help with the figures. We also thank all patients for their participation in the study and all colleagues for their cooperation and support during the study. The study was supported by grants from the Swedish Rheumatism Association, the Swedish Research Council, the Medical Faculty of the University of Lund, Alfred Österlund's Foundation, The Crafoord Foundation, Greta and Johan Kock's foundation and The King Gustaf V 80th Birthday Fund, and Lund University Hospital. Prevenar vaccine for this study was provided by Wyeth Pharmaceuticals.

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Authors and Affiliations

  1. Department of Clinical Sciences Lund, Section of Rheumatology, Skåne University Hospital, Lund University, Kioskgatan 3, SE-221 85, Lund, Sweden

    Meliha Crnkic Kapetanovic & Carmen Roseman

  2. Department of Clinical Sciences Lund, Section of Infectious Diseases, Skåne University Hospital, Lund University, Lund, Sweden

    Göran Jönsson

  3. Department of Laboratory Medicine Lund, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden

    Lennart Truedsson

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  1. Meliha Crnkic Kapetanovic
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  2. Carmen Roseman
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  4. Lennart Truedsson
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Correspondence to Meliha Crnkic Kapetanovic.

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Kapetanovic, M.C., Roseman, C., Jönsson, G. et al. Heptavalent pneumococcal conjugate vaccine elicits similar antibody response as standard 23-valent polysaccharide vaccine in adult patients with RA treated with immunomodulating drugs. Clin Rheumatol 30, 1555–1561 (2011). https://doi.org/10.1007/s10067-011-1856-5

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  • DOI: https://doi.org/10.1007/s10067-011-1856-5

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