OBJECTIVE: To assess the current literature on the impact of rheumatoid arthritis (RA) treatments on the humoral response to pneumococcal and influenza vaccines. METHODS: We systematically searched the literature for studies evaluating the immune response to vaccines in RA patients receiving methotrexate (MTX) and/or biologic agents. The efficacy of vaccination, assessed by the response rate based on increased antibody titers before and 3-6 weeks after vaccination, was extracted by one investigator and verified by another. RESULTS: In total, 12 studies were included. RA patients mainly received MTX, anti-tumor necrosis factor α (anti-TNFα), or rituximab (RTX). Influenza vaccination response was reduced for RTX (43 patients; pooled odds ratio [OR] 0.44 [95% confidence interval (95% CI) 0.17-1.12] for H1N1, OR 0.11 [95% CI 0.04-0.31] for H3N2, and OR 0.29 [95% CI 0.10-0.81] for B) but not for anti-TNFα (308 patients; OR 0.93 [95% CI 0.36-2.37] for H1N1, OR 0.79 [95% CI 0.34-1.83] for H3N2, and OR 0.79 [95% CI 0.37-1.70] for B). For MTX, results differed depending on the method of analysis (222 patients; OR 0.35 [95% CI 0.18-0.66] for at least 2 strains, ORs were close to 1.0 in the single strain analysis). Pneumococcal vaccination response was reduced for 139 patients receiving MTX compared with controls (OR 0.33 [95% CI 0.20-0.54] for serotype 6B and OR 0.58 [95% CI 0.36-0.94] for 23F) but not for anti-TNFα (258 patients; OR 0.96 [95% CI 0.57-1.59] for 6B and OR 1.20 [95% CI 0.57-2.54] for 23F). For RTX, the response was reduced (88 patients; OR 0.25 [95% CI 0.11-0.58] for 6B and OR 0.21 [95% CI 0.04-1.05] for 23F). CONCLUSION: MTX decreases humoral response to pneumococcal vaccination and may impair response to influenza vaccination. The immune response to both vaccines is reduced with RTX but not with anti-TNFα therapy in RA patients.
OBJECTIVE: To assess the current literature on the impact of rheumatoid arthritis (RA) treatments on the humoral response to pneumococcal and influenza vaccines. METHODS: We systematically searched the literature for studies evaluating the immune response to vaccines in RApatients receiving methotrexate (MTX) and/or biologic agents. The efficacy of vaccination, assessed by the response rate based on increased antibody titers before and 3-6 weeks after vaccination, was extracted by one investigator and verified by another. RESULTS: In total, 12 studies were included. RApatients mainly received MTX, anti-tumor necrosis factor α (anti-TNFα), or rituximab (RTX). Influenza vaccination response was reduced for RTX (43 patients; pooled odds ratio [OR] 0.44 [95% confidence interval (95% CI) 0.17-1.12] for H1N1, OR 0.11 [95% CI 0.04-0.31] for H3N2, and OR 0.29 [95% CI 0.10-0.81] for B) but not for anti-TNFα (308 patients; OR 0.93 [95% CI 0.36-2.37] for H1N1, OR 0.79 [95% CI 0.34-1.83] for H3N2, and OR 0.79 [95% CI 0.37-1.70] for B). For MTX, results differed depending on the method of analysis (222 patients; OR 0.35 [95% CI 0.18-0.66] for at least 2 strains, ORs were close to 1.0 in the single strain analysis). Pneumococcal vaccination response was reduced for 139 patients receiving MTX compared with controls (OR 0.33 [95% CI 0.20-0.54] for serotype 6B and OR 0.58 [95% CI 0.36-0.94] for 23F) but not for anti-TNFα (258 patients; OR 0.96 [95% CI 0.57-1.59] for 6B and OR 1.20 [95% CI 0.57-2.54] for 23F). For RTX, the response was reduced (88 patients; OR 0.25 [95% CI 0.11-0.58] for 6B and OR 0.21 [95% CI 0.04-1.05] for 23F). CONCLUSION:MTX decreases humoral response to pneumococcal vaccination and may impair response to influenza vaccination. The immune response to both vaccines is reduced with RTX but not with anti-TNFα therapy in RApatients.
Authors: Saad B Omer; Varun K Phadke; Robert A Bednarczyk; Allison T Chamberlain; Jennifer L Brosseau; Walter A Orenstein Journal: J Infect Dis Date: 2015-10-28 Impact factor: 5.226
Authors: Ursula Wiedermann; Harald H Sitte; Heinz Burgmann; Alexander Eser; Petra Falb; Heidemarie Holzmann; Maria Kitchen; Marcus Köller; Herwig Kollaritsch; Michael Kundi; Hans Lassmann; Ingomar Mutz; Winfried F Pickl; Elisabeth Riedl; Maria Sibilia; Florian Thalhammer; Barbara Tucek; Werner Zenz; Karl Zwiauer Journal: Wien Klin Wochenschr Date: 2016-07-25 Impact factor: 1.704
Authors: Amit Saxena; Allison Guttmann; Mala Masson; Mimi Y Kim; Rebecca H Haberman; Rochelle Castillo; Jose U Scher; Kristina K Deonaraine; Alexis J Engel; H Michael Belmont; Ashira D Blazer; Jill P Buyon; Ruth Fernandez-Ruiz; Peter M Izmirly Journal: Lancet Rheumatol Date: 2021-05-27
Authors: Daniel Mrak; Selma Tobudic; Maximilian Koblischke; Marianne Graninger; Helga Radner; Daniela Sieghart; Philipp Hofer; Thomas Perkmann; Helmuth Haslacher; Renate Thalhammer; Stefan Winkler; Stephan Blüml; Karin Stiasny; Judith H Aberle; Josef S Smolen; Leonhard X Heinz; Daniel Aletaha; Michael Bonelli Journal: Ann Rheum Dis Date: 2021-07-20 Impact factor: 19.103