Patients with Crohn's disease on anti-tumor necrosis factor therapy are at significant risk of inadequate response to the 23-valent pneumococcal polysaccharide vaccineopen access
- Lee, Chang Kyun; Kim, Hyun-Soo; Ye, Byong Duk; Lee, Kang-Moon; Kim, You Sun; Rhee, Sang Youl; Kim, Hyo-Jong; Yang, Suk-Kyun; Moon, Won; Koo, Ja-Seol; Lee, Suck-Ho; Seo, Geom Seog; Park, Soo Jung; Choi, Chang Hwan; Jung, Sung-Ae; Hong, Sung Noh; Im, Jong Pil; Kim, Eun Soo
- Issue Date
- OXFORD UNIV PRESS
- Crohn' s disease; Inflammatory bowel disease; Innnnunosuppressive agents; Pneumococcal vaccine
- JOURNAL OF CROHNS & COLITIS, v.8, no.5, pp.384 - 391
- Journal Title
- JOURNAL OF CROHNS & COLITIS
- Start Page
- End Page
- 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 imnnunosuppressants 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 4 weeks 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 atone; 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. (C) 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
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- 2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles
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