Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr 5:2:12.
doi: 10.1186/s41927-018-0019-6. eCollection 2018.

Antibody response to 13-valent pneumococcal conjugate vaccine is not impaired in patients with rheumatoid arthritis or primary Sjögren's syndrome without disease modifying treatment

Per Nived  1   2 , Tore Saxne  1 , Pierre Geborek  1 , Thomas Mandl  3 , Lillemor Skattum  4   5 , Meliha C Kapetanovic  1
Affiliations

Antibody response to 13-valent pneumococcal conjugate vaccine is not impaired in patients with rheumatoid arthritis or primary Sjögren's syndrome without disease modifying treatment

Per Nived et al. BMC Rheumatol. .

Abstract

Background: Pneumococcal vaccination is recommended to patients with rheumatoid arthritis (RA) and primary Sjögren's syndrome (pSS). However, little is known whether the diseases influence pneumococcal vaccine response. This study aimed to investigate antibody response and functionality of antibodies following immunization with 13-valent pneumococcal conjugate vaccine (PCV13) in RA patients or pSS patients without disease modifying anti-rheumatic drugs (DMARD), compared to patients with RA treated with DMARD or to healthy controls.

Methods: Sixty RA patients (50 without DMARD and 10 with MTX), 15 patients with pSS and 49 controls received one dose of PCV13. Serotype-specific antibody concentrations for pneumococcal polysaccharides 6B and 23F and functionality of antibodies (23F) were determined in serum taken before and 4-6 weeks after vaccination using ELISA and opsonophagocytic activity assay (OPA), respectively. Proportions of individuals with positive antibody response (i.e. ≥ 2-fold increase from prevaccination concentrations; antibody response ratio; ARR ≥ 2), percentage of individuals reaching putative protective antibody level (i.e. ≥1.3 μg/mL) for both serotypes, and difference in OPA were calculated.

Results: After vaccination, antibody concentrations for both serotypes increased in RA without DMARD (p < 0.001), pSS (p ≤ 0.05 and < 0.01) and controls (p < 0.001). Antibody responses to 6B and 23F were comparable in RA without DMARD (64% and 74%), pSS (67% and 53%) and controls (65% and 67%), but lower in the small group RA with MTX (both 20%, p < 0.01). Similarly, significant increases of patients reaching protective antibody levels were seen in RA without DMARD (p ≤ 0.001) and controls (p < 0.001). After vaccination, OPA increased significantly in controls, RA and pSS without DMARD (p < 0.001 to 0.03), but not in RA with MTX.

Conclusions: Pneumococcal conjugate vaccine is immunogenic in RA and pSS patients without DMARD and in line with previous studies we support the recommendation that vaccination of RA patients should be performed before the initiation of MTX.

Trial registration: ClinicalTrials.gov Identifier: NCT02240888. Retrospectively registered 4 September, 2014.

Keywords: Pneumococcal conjugate vaccine; Pneumococcal vaccination; Rheumatoid arthritis; Sjögren’s syndrome.

PubMed Disclaimer

Conflict of interest statement

The study was approved by the Regional Ethical Review Board at Lund University, Sweden (Dnr 2011/341). Consecutive patients fulfilling inclusion criteria were invited to participate in the study. Oral and written information was provided to all subjects who were invited to participate, and written consent was obtained from each participant before enrolment.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Proportions of subjects with a positive antibody response PCV13 vaccination
Fig. 2
Fig. 2
a Opsonophagocytic activity before and after PCV13 vaccination in RA and controls. b Opsonophagocytic activity before and after PCV13 vaccination in primary Sjögren’s syndrome and controls
See this image and copyright information in PMC

References

    1. Naz SM, Symmons DPM. Mortality in established rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21:871–883. doi: 10.1016/j.berh.2007.05.003. - DOI - PubMed
    1. Flament T, Bigot A, Chaigne B, Henique H, Diot E, Marchand-Adam S. Pulmonary manifestations of Sjögren’s syndrome. Eur Respir Rev. 2016;25:110–123. doi: 10.1183/16000617.0011-2016. - DOI - PMC - PubMed
    1. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002;46:2287–2293. doi: 10.1002/art.10524. - DOI - PubMed
    1. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Predictors of infection in rheumatoid arthritis. Arthritis Rheum. 2002;46:2294–2300. doi: 10.1002/art.10529. - DOI - PubMed
    1. Singh JA, Cameron C, Noorbaloochi S, Cullis T, Tucker M, Christensen R, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. 2015;386:258–265. doi: 10.1016/S0140-6736(14)61704-9. - DOI - PMC - PubMed

Associated data