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Vaccine. 2018 Sep 18;36(39):5832-5845. doi: 10.1016/j.vaccine.2018.07.039. Epub 2018 Aug 16.

The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: A systematic review and meta-analysis.

Author information

1
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, Amsterdam, The Netherlands.
2
Medical Library, Academic Medical Center, Amsterdam, The Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Pieterbergweg 17, 1105BM Amsterdam, The Netherlands.
4
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, Amsterdam, The Netherlands; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
5
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, Amsterdam, The Netherlands. Electronic address: a.goorhuis@amc.uva.nl.

Abstract

INTRODUCTION:

Patients with a weakened immune system due to immunosuppressive treatment are at increased risk of infection with Streptococcus pneumoniae. Although pneumococcal vaccination is highly recommended for those patients, the effectiveness of pneumococcal vaccination in this population remains largely unknown. Therefore, the objective of this PROSPERO-registered systematic review and meta-analysis was to evaluate the effect of the most commonly prescribed immunosuppressive agents such as azathioprine, methotrexate, anti-Tumor Necrosis Factor α (TNFα), or rituximab, on the initial serologic response to pneumococcal vaccination in patients with auto-immune disease.

METHODS:

We included 22 articles comprising 2077 patients, of whom 1623 were treated with immunosuppressive agents, and 454 were controls.

RESULTS AND DISCUSSION:

The findings of our systematic review indicate that, in patients treated with immunosuppressive medication and compared to controls, the initial serologic response to pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are impaired. Moreover, this impaired response was more profound after PCV than after PPSV. We hypothesize that the immunosuppressive medication mainly compromises the cellular immunity, explaining the more severely reduced response rate to PCV (which induces a T-cell dependent immune response), compared to PPSV. Treatment with TNFα blocking agents was associated with a more favorable response, compared to patients treated with other immunosuppressive medication. Targeted research applying uniform correlates of protection is needed to bridge the knowledge gap in vaccination immunology in this patient group. PROSPERO registration: CRD42017058364.

KEYWORDS:

Auto-immune disease; Immunogenicity; Immunosuppressive therapy; PCV; PPSV; Pneumococcal vaccination

PMID:
30122649
DOI:
10.1016/j.vaccine.2018.07.039
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