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. 2021 Feb 28;9(3):203.
doi: 10.3390/vaccines9030203.

Impact of Biological Therapies on the Immune Response after Pneumococcal Vaccination in Patients with Autoimmune Inflammatory Diseases

Patricia Richi  1   2 , Jose Yuste  3   4 , Teresa Navío  5 , Laura González-Hombrado  6 , Marina Salido  7 , Israel Thuissard-Vasallo  8 , Ana Jiménez-Díaz  1 , Jesús Llorente  9 , Laura Cebrián  5 , Leticia Lojo  5 , Martina Steiner  1   2 , Tatiana Cobo  1   2 , María Dolores Martín  10 , Marta García-Castro  6 , Patricia Castro  7 , Santiago Muñoz-Fernández  1   2
Affiliations

Impact of Biological Therapies on the Immune Response after Pneumococcal Vaccination in Patients with Autoimmune Inflammatory Diseases

Patricia Richi et al. Vaccines (Basel). .

Abstract

Patients with different autoimmune inflammatory diseases (AIID) on biological therapy are at risk of pneumococcal disease. Adults with inflammatory arthropathies, connective tissue diseases, psoriasis, or inflammatory bowel disease on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included in this study. Patients completed a protocol combining the pneumococcal vaccines PCV13 and PPV23. Immune response against pneumococcal serotypes 1, 3, 7F, 14, 19A, and 19F were assessed evaluating functional antibodies by an opsonophagocytosis killing assay (OPKA). In this study, 182 patients with AIID completed the sequential vaccination protocol. Patients on etanercept tended to achieve OPKA titers against a larger number of serotypes than the rest of patients on other biological therapies, while adalimumab was associated to a lower number of serotypes with OPKA titers. Rituximab was not associated with a worse response when compared with the rest of biological agents. Not glucocorticoids, nor synthetic disease-modifying antirheumatic drugs, interfered with the immune response. OPKA titers against serotype 3 which is one of the most prevalent, was obtained in 44% of patients, increasing up to 58% in those on etanercept. Hence, almost 50% of patients on biological therapy achieved functional antibodies after the administration of a complete pneumococcal vaccination protocol.

Keywords: OPKA titers; PCV13; PPV23; anti-TNFα; autoimmune inflammatory diseases; biological therapy; invasive pneumococcal disease; rituximab; tocilizumab.

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Conflict of interest statement

P.R. declares she has received research grants from Sociedad de Reumatología Comunidad de Madrid (SORCOM)/MSD and Pfizer. J.Y. reports grants from MSD-USA, and personal fees from GSK, MSD and Pfizer, outside the submitted work. S.M.F. declares he has received research grants from Sociedad de Reumatología Comunidad de Madrid (SORCOM)/MSD and Pfizer, and personal fees from Abbvie, Janssen, Novartis, Roche, Sanofi, MSD and Celgene and Pfizer, outside the submitted work. The rest of authors declare that they have no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow diagram of patients included, excluded and finally analyzed.
Figure 2
Figure 2
Serotypes included in PCV13 (red color) and PPV23 (green color) and serotypes evaluated for opsonophagocytosis killing assays (hatched). Nonvaccine serotypes (white color).
Figure 3
Figure 3
Patients with OT > 50% against each serotype, depending on the biological agent received. Abatacept and anakinra were not included due to the scarce number of patients. St (serotype), OT (opsonization titers).
Figure 4
Figure 4
Patients with OT > 50% against each serotype, depending on the diagnosis. Abatacept and anakinra were not included due to the scarce number of patients. St (serotype), OT (opsonization titers).
See this image and copyright information in PMC

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