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Meta-Analysis
. 2019 Sep 9;5(2):e001035.
doi: 10.1136/rmdopen-2019-001035. eCollection 2019.

Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations

Christien Rondaan #  1   2 , Victoria Furer #  3   4 , Marloes W Heijstek  5 , Nancy Agmon-Levin  4   6 , Marc Bijl  7 , Ferdinand C Breedveld  8 , Raffaele D'Amelio  9 , Maxime Dougados  10   11 , Meliha C Kapetanovic  12 , Jacob M van Laar  13 , Annette Ladefoged de Thurah  14 , Robert Landewé  15   16 , Anna Molto  10 , Ulf Müller-Ladner  17 , Karen Schreiber  18   19 , Leo Smolar  20 , Jim Walker  21 , Klaus Warnatz  22 , Nico M Wulffraat  23 , Sander van Assen  24 , Ori Elkayam  3   4
Affiliations
Meta-Analysis

Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations

Christien Rondaan et al. RMD Open. .

Abstract

Aim: To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations.

Methods: An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018).

Results: While most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved.

Conclusion: Evidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.

Keywords: autoimmune diseases; infections; vaccination.

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Conflict of interest statement

Competing interests: KW reports personal fees from Pfizer, during the conduct of the study; grants and personal fees from Biotest, CSL Behring, personal fees from LFB, Grifols, Baxter, Roche, Octapharma, grants from BMS, outside the submitted work. AM reports grants and personal fees from ABBVIE, Pfizer, BMS, UCB, MERCK, during the conduct of the study. MD reports grants and personal fees from PFIZER, ABBVIE, UCB, NOVARTIS, LILLY, MERCK, ROCHE, grants from BMS, outside the submitted work. OE reports grants and personal fees from Pfizer, Abbvie, Roche, Janssen, personal fees from Novartis and Lilly. All other authors have no conflicts of interests to declare.

Figures

Figure 1
Figure 1
Flow chart displaying the search strategy for PICO 2 and 3. DMARDs, disease-modifying antirheumatic drugs; IS, immunosuppressives; PICO, population-intervention-comparison-outcome.
See this image and copyright information in PMC

References

    1. Furer V, Rondaan C, Heijstek M, et al. Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review Informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. RMD Open 2019. - PMC - PubMed
    1. van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22. 10.1136/ard.2010.137216 - DOI - PubMed
    1. Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2019. 10.1136/annrheumdis-2019-215882. [Epub ahead of print: 14 Aug 2019]. - DOI - PubMed
    1. van der Heijde D, Aletaha D, Carmona L, et al. 2014 update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann Rheum Dis 2015;74:8–13. 10.1136/annrheumdis-2014-206350 - DOI - PMC - PubMed
    1. Phillips B, Ball C, Sackett D, et al. Last update by Howick J. Oxford centre for evidence-based medicine – levels of evidence (March 2009), 2018.

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