Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Heptavalent Conjugate Pneumococcal Vaccine (Prevenar) Elicits Similar Antibody Responses as 23-Valent Polysaccharide Vaccine (PPV) in Adult Patients with Established Arthritis.

Kapetanovic1,  Meliha C., Roseman2,  Carmen, Jonsson1,  Göran, Truedsson3,  Lennart, Saxne1,  Tore, Geborek1,  Pierre

Dept of Clinical Sciences Lund, Section of Infectious Diseases, Lund University, Lund, Sweden
Dept of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
Dept of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden

Background:

The immunogenicity of 23-valent polysaccharide vaccine (PPV) is debated. Heptavalent conjugate pneumococcal vaccine (Prevenarâ) has been shown to elicit better immune responses compared to PPV in children and healthy adults. Corresponding data in patients with inflammatory rheumatic diseases receiving immunosuppressive treatments is lacking.

Aim:

To study immune response after vaccination with A) Prevenarâ in immunosuppressed patients with rheumatoid arthritis (RA) and patients with spondylarthropathy including psoriatic arthritis (SpA) not receiving immunosuppressive treatment compared to B) immunosuppressed RA patients and healthy controls vaccinated with PPV.

Patients and Methods:

In total, 254 patients with RA on methotrexate alone, TNF-blockers as monotherapy or methotrexate +TNF blockers and 86 patients with SpA not treated with immunosuppressive drugs received a single dose (0.5 ml) of Prevenarâ. Altogether, 149 patients with RA receiving corresponding immunosuppressive treatments and 47 healthy controls were vaccinated with 0.5 ml of a single lot of PPV, as previously reported (ref). Levels of serotype specific IgG to 23 F and 6B were measured prior to vaccination and 4–6 weeks after vaccination using standard ELISA. Pre- and postvaccination antibody levels for each serotype and immune response (IR), defined as ratio between post- and prevaccination antibody levels, were compared between the groups. Differences in IR were analysed using univariate analysis of variance (ANCOVA) adjusted for age, gender, prevaccination antibody levels, and concomitant methotrexate /prednisolone treatment when appropriate.

Results:

Pneumococcal vaccination resulted in significant increase in post-vaccination antibody levels in all groups compared to baseline levels for both serotypes. RA patients vaccinated with Prevenarâ gained in general similar postvaccination antibody levels and IR as those receiving PPV (Table1). SpA patients had better IR for serotype 23F compared to healthy controls who received PPV vaccine. Among Prevenarâ vaccinated RA patients, IR was similar in the respective treatment modalities as those receiving PPV.

Conclusion:

Pneumococcal vaccination using conjugate vaccine elicits similar immune response as 23-valent polysaccharide vaccine in patients with established RA receiving immunosuppressive treatments. Pneumoccal conjugate vaccine did not give better immune response in general but may be better for some serotype.

Table 1. Demographic characteristics and immunization response (IR) for serotype 23 F and 6B in different groups vaccinated with Prevenarâor 23-valent polysaccharide vaccine (PPV).

 PrevenarPPV
 RA patients (N=254)Spondylarthropathy patients (N=86)RA patients (N=149)Healthy controls (N=47)
Age (years) (mean)60 (13)52 (12)55 (13)36 (12)
Female (%)80%45%72%75%
Disease duration at vaccination (years)16 (12)12 (12)16 (11)
Immunization response (IR) for 23F (median; min-max)1.99 (0.51–740)4.96 (0.17–120)*2.02 (0.25–67)2.28 (0.18–91)
Immunization response (IR) for 6B (median; min-max)1.38 (0.38–100)2.1 (0.24–129)2.13 (0.8–280)2.22 (0.40–75)
* p=0.005 between SpA and healthy controls (univariate analysis of variance; ANCOVA, adjusted for age, sex and prevaccination antibody levels)

1Kapetanovic, Ref. et al. Rheumatology 2006; 45:110–116

To cite this abstract, please use the following information:
Kapetanovic, Meliha C., Roseman, Carmen, Jonsson, Göran, Truedsson, Lennart, Saxne, Tore, Geborek, Pierre; Heptavalent Conjugate Pneumococcal Vaccine (Prevenar) Elicits Similar Antibody Responses as 23-Valent Polysaccharide Vaccine (PPV) in Adult Patients with Established Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1037
DOI: 10.1002/art.28804

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