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
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
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Several vaccine preventable infections occur more often in patients with AIIRD.
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Most vaccines are efficacious in patients with AIIRD, even when treated with immunomodulating agents, with an exception being rituximab.
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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.
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More research is needed in particular regarding incidence of
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