Elsevier

Autoimmunity Reviews

Volume 10, Issue 6, April 2011, Pages 341-352
Autoimmunity Reviews

Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: A systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases

https://doi.org/10.1016/j.autrev.2010.12.003Get rights and content

Abstract

Objectives

To present the systematic literature review (SLR), which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases (AIIRD).

Methods

AIIRD, vaccines and immunomodulating drugs, as well as eight key questions were defined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A SLR was performed using MedLine through October 2009 and including data from meta-analyses, systematic reviews, randomized trials, and observational studies, excluding case series with ≤ 5 participants. Articles in English and regarding patients ≥ 16 years of age, were eligible.

Results

Several vaccine-preventable infections (VPI) occur more often in AIIRD-patients and most vaccines are efficacious in AIIRD-patients, even when treated with immunomodulating agents, except rituximab. There does not appear to be an increase in vaccination-related harms in vaccinated patients with AIIRD in comparison with unvaccinated patients with AIIRD. However, these studies are underpowered and therefore not conclusive.

Conclusion

Based on the current evidence from the literature, recommendations for vaccination in patients with AIIRD were made. However, more research is needed in particular regarding incidence of VPI, harms of vaccination and the influence of (new and established) immunomodulating agents on vaccination efficacy.

Section snippets

Methods

The expert committee formulated eight key questions to be addressed for the SLR, performed by SvA, MB, NAL and OE. Twenty-seven predefined AIIRD conditions, 29 vaccines and 17 immunosuppressive medications (Table 1) were used as search terms, using MedLine (via PubMed; from 1966 to October 2009) and the abstracts from the meetings of EULAR 2008 and 2009 and the American College of Rheumatology (ACR) 2007 and 2008. Only articles in English and concerning patients older than 16 years of age were

Question 1

Is the risk of infections for which vaccines are available increased in patients with AIIRD in general, and specifically in those with active disease, and in those using immunomodulating agents?

Discussion

This SLR summarizes the available evidence regarding vaccination in patients with AIIRD. By defining 8 key questions we were able to address the most important issues, mainly the indication, the efficacy and the possible harms of vaccination in these patients. Unfortunately, studies investigating the incidence of VPI in AIIRD-patients are scarce and no RCT with clinical primary endpoints regarding efficacy were available. Moreover, although vaccination did not lead to significant harms in the

Funding

EULAR.

Take-home messages

  • Several vaccine preventable infections occur more often in patients with AIIRD.

  • Most vaccines are efficacious in patients with AIIRD, even when treated with immunomodulating agents, with an exception being rituximab.

  • Vaccination-related harms do not seem to be increased in vaccinated patients with AIIRD in comparison with unvaccinated patients with AIIRD, although these studies are underpowered and therefore not conclusive.

  • More research is needed in particular regarding incidence of

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