The Effect of tumor necrosis factor blockade on the response to pneumococcal vaccination in patients with rheumatoid arthritis and ankylosing spondylitis☆
Section snippets
Subjects
The study group included 11 consecutive patients who fulfilled the American College of Rheumatology criteria for RA (13) and 5 patients who fulfilled the New York Clinical criteria for AS. All patients were treated with TNF-α blockade: either intravenous infliximab at a dosage of 3 mg/kg at week 0, week 2, week 6, and every 8 weeks thereafter, or subcutaneous etanercept 25 mg, twice a week. Because age plays an important role in the response to pneumococcal vaccine (14), the control group
Characteristics of patients and control subjects
The TNF-α blockade-treated patients and the control group did not differ significantly by age, gender, duration of disease, or in use of nonsteroidal anti-inflammatory drugs (NSAIDs) or methotrexate (MTX) (Table 1). Both groups were predominantly female, and approximately 30% of patients were receiving NSAIDs and 60% to 65% were receiving MTX. Significantly more patients in the control group were treated with prednisone, or using doses >10 mg/d, compared with the TNF-α blockade-treated
Discussion
In this study, we have shown that pneumococcal vaccination, using the commercial 23-valent pneumococcal polysaccharide vaccine, can induce statistically significant humoral responses despite treatment with TNF-α blockade therapies. Our data are in agreement with a preliminary report suggesting that treatment with etanercept does not interfere with mean immune responses to pneumococcal vaccination in patients with psoriatic arthritis (19). However, a smaller percentage of the TNF-α
Ori Elkayam, MD: Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Cited by (0)
Ori Elkayam, MD: Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Dan Caspi, MD: Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Tatiana Reitblatt, MD: Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Darlene Charboneau: Pulmonary Division, Minneapolis VA Medical Center, Minneapolis, Minnesota
Jeffrey B. Rubins, MD: Pulmonary Division, Minneapolis VA Medical Center, Minneapolis, Minnesota
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Supported by National Institutes of Health Grant IH AI02440 (to J.B.R.).