TNF-α Antagonists and Immunization.

Tumor necrosis factor (TNF) antagonists have proven to be very effective in the treatment of several autoimmune-mediated inflammatory diseases. The two classes of TNF antagonists-soluble TNF receptors and TNF monoclonal antibodies-have several important structural, pharmacokinetic, and functional differences. TNF antagonists interfere at different steps in the immune response to infections and vaccines. The immune response to pneumococcal polysaccharide vaccines is impaired in patients treated with methotrexate with some additional immunosuppressive effect of TNF antagonists. The secondary immune responses to inactivated and live attenuated vaccines, such as yellow fever vaccine, during treatment with TNF antagonists is mostly adequate despite significantly lower antibody levels. Little is known about the primary immune response to inactivated travel-related vaccines, but it is likely to be poor. Primary vaccination with live attenuated vaccines of patients receiving TNF antagonists should be avoided at all times.