Effect of Anti-TNFalpha Therapies on the Immunogenecity of Pneumococcal Vaccination in Patients with Rheumatic Diseases

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Effect of Anti-TNFalpha Therapies on the Immunogenecity of Pneumococcal

Vaccination in Patients with Rheumatic Diseases

Category:  16 RA‹clinical aspects

Ori Elkayam1, Dan Caspi1, Daphna Paran1, Tatiana Reitblat1, Irena Litinsky1,

Yaron1, Jeff Rubins2

1Tel Aviv Medical Center, Tel Aviv, Israel2Veterans Affair Medical Center,

Minneapolis, MN

Presentation Number: 861

Poster Board Number: 326

Keywords: anti TNFalpha, Pneumococcal, vaccine

OBJECTIVE: to assess the effect of anti TNFÉø therapies (Infliximab or

Etanercept) on the immunogenecity of vaccination against streptococcal

pneumonia in patients with rheumatoid arthritis (RA) and ankylosing

spondylitis (AS).

METHOD: Sixteen consecutive patients (11 with RA and 5 with AS) treated

either with Infliximab or Etanercept, 42 RA patients not treated with

infliximab or etanercept and 20 healthy controls received intradeltoid

injection with 0.5 mL of pneumococcal vaccine. Pneumococcal polysaccharide

(PPS)-specific IgG to seven vaccine PPS (representing high and low

prevalence serotypes) was measured by ELISA in sera obtained before, and at

one month after pneumococcal immunization.

RESULTS: In general, prevaccination antibody levels to the 7 pneumococcal

serotypes tested did not differ significantly between groups. One month

after vaccination, all groups had significant increases in geometric mean

concentration of capsule pneumococcal polysaccharide-specific antibody and

in the mean fold increase in antibody levels to all 7 serotypes, compared

with prevaccination levels. However, the anti-TNF Éø treated patients tended

to have lower antibody increases for all the serotypes tested excepted

serotypes 14 .When individual responses were tested and according to the

several serotypes, only 12 to 56 % of anti TNF Éø treated patients responded

to pneumococcal vaccination, in comparison with 35%-71% non anti TNF Éø

treated RA patients and 55-95 % of healthy controls. The differences reached

statistical significance for 7F, 23 F and 4.

CONCLUSION: In conclusion, treatment with etanercept or infliximab does not

seem to affect the antibody response to pneumococcal vaccination. However,

since individual patients may not respond adequately, it seems wise to

vaccinate patients prior starting treatment with anti TNFÉø therapy.