Chang Kyun Lee1, Hyun-Soo Kim2, Byong Duk Ye3, Kang-Moon Lee4, You Sun Kim5, Sang Youl Rhee1, Hyo-Jong Kim1, Suk-Kyun Yang3, Won Moon6, Ja-Seol Koo7, Suck-Ho Lee8, Geom Seog Seo9, Soo Jung Park10, Chang Hwan Choi11, Sung-Ae Jung12, Sung Noh Hong13, Jong Pil Im14, Eun Soo Kim15. 1. Kyung Hee University School of Medicine, Seoul, Republic of Korea. 2. Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. Electronic address: hyskim@yonsei.ac.kr. 3. University of Ulsan College of Medicine, Seoul, Republic of Korea. 4. The Catholic University of Korea School of Medicine, Seoul, Republic of Korea. 5. Inje University College of Medicine, Seoul, Republic of Korea. 6. Kosin University College of Medicine, Busan, Republic of Korea. 7. Korea University College of Medicine, Seoul, Republic of Korea. 8. Soonchunhyang University College of Medicine, Cheonan, Republic of Korea. 9. Wonkwang University School of Medicine, Iksan, Republic of Korea. 10. Yonsei University College of Medicine, Seoul, Republic of Korea. 11. Chung-Ang University College of Medicine, Seoul, Republic of Korea. 12. Ewha Womans University School of Medicine, Seoul, Republic of Korea. 13. Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 14. Seoul National University College of Medicine, Seoul, Republic of Korea. 15. Keimyung University School of Medicine, Daegu, Republic of Korea.
Abstract
BACKGROUND/AIMS: The effect of immunosuppressants on the efficacy of a variety of vaccines is a controversial issue in patients with inflammatory bowel disease (IBD). In this study we determined whether specific immunosuppressants impair the serological response to the standard 23-valent pneumococcal polysaccharide vaccine (PPSV23) in a large cohort of patients with Crohn's disease (CD). METHODS: This was a multi-center, prospective observational study of adult patients with CD at 15 academic teaching hospitals in Korea. The study population received one intramuscular injection of PPSV23. Anti-pneumococcal IgG antibody titers were measured by immunoassay prior to and 4weeks after vaccination. All vaccination-related adverse events and the effect of the vaccine on disease activity were also evaluated. RESULTS: The overall serological response rate was 67.5% (133/197). The serological response rate was significantly lower in patients on anti-tumor necrosis factor (anti-TNF) therapy (50.0% on anti-TNF alone; 58.0% on anti-TNF combined with an immunomodulator, IM) than patients on 5-aminosalicylate (78.4%; all P-values vs. 5-aminosalicylate<0.05); 45.6% (41/90) of patients on anti-TNF therapy were not protected against PPSV23. IM did not affect the immunologic response to the vaccine. Female gender and anti-TNF therapy were significant predictors of non-response to the vaccine (odds ratio [OR] 2.316, P=0.015; OR 2.582, P=0.048, respectively). Vaccination was generally safe and tolerated by all patients. CONCLUSIONS: Patients with CD on anti-TNF therapy are at significant risk of an inadequate response to PPSV23. The pneumococcal vaccination strategy should be optimized for patients with CD on anti-TNF therapy.
BACKGROUND/AIMS: The effect of immunosuppressants on the efficacy of a variety of vaccines is a controversial issue in patients with inflammatory bowel disease (IBD). In this study we determined whether specific immunosuppressants impair the serological response to the standard 23-valent pneumococcalpolysaccharide vaccine (PPSV23) in a large cohort of patients with Crohn's disease (CD). METHODS: This was a multi-center, prospective observational study of adult patients with CD at 15 academic teaching hospitals in Korea. The study population received one intramuscular injection of PPSV23. Anti-pneumococcal IgG antibody titers were measured by immunoassay prior to and 4weeks after vaccination. All vaccination-related adverse events and the effect of the vaccine on disease activity were also evaluated. RESULTS: The overall serological response rate was 67.5% (133/197). The serological response rate was significantly lower in patients on anti-tumor necrosis factor (anti-TNF) therapy (50.0% on anti-TNF alone; 58.0% on anti-TNF combined with an immunomodulator, IM) than patients on 5-aminosalicylate (78.4%; all P-values vs. 5-aminosalicylate<0.05); 45.6% (41/90) of patients on anti-TNF therapy were not protected against PPSV23. IM did not affect the immunologic response to the vaccine. Female gender and anti-TNF therapy were significant predictors of non-response to the vaccine (odds ratio [OR] 2.316, P=0.015; OR 2.582, P=0.048, respectively). Vaccination was generally safe and tolerated by all patients. CONCLUSIONS:Patients with CD on anti-TNF therapy are at significant risk of an inadequate response to PPSV23. The pneumococcal vaccination strategy should be optimized for patients with CD on anti-TNF therapy.
Authors: Murat Törüner; İsmail Hakkı Kalkan; Filiz Akyüz; Ahmet Tezel; Aykut Ferhat Çelik Journal: Turk J Gastroenterol Date: 2021-06 Impact factor: 1.852