Method: Altogether, 294 patients with established RA and 86 patients with spondylartropathy (SpA) including psoriatic arthritis received one dose of 0.5 ml Prevenar® intramuscularly. The RA treatment groups (number of participants, % female, mean age (years)) were studied: MTX (85; 79; 62); anti-TNF as monotherapy (79; 87; 60); anti-TNF+MTX (89; 78; 60); RTX as monotherapy (15; 80; 68); RTX+MTX (10; 70; 56); abatacept (10; 100; 57) and tocilizumab (5; 100; 62). SpA patients on NSAIDs/analgesics (86; 39; 52) served as controls. Levels of serotype specific IgG against 23F and 6B were measured at vaccination and 4-6 weeks after vaccination using standardised ELISA. Antibody response ratio (ARR) calculated on logarithmic values as ratio post/prevaccination antibody levels were compared between treatment groups. Positive antibody response (posAR) was defined as ≥2 ARR.
Result: ARR different significantly between the groups for both serotypes (univariate analysis of variance, ANCOVA; p<0.001). Compared to controls, all other RA treatments groups showed significantly lower ARR except for patients treated with anti-TNF as monotherapy for both serotypes (p-value between 0.023 and <0.001). Furthermore, patients receiving RTX as monotherapy or RTX+ MTX showed significantly decreased ARR compared to anti-TNF as monotherapy and MTX alone. None of RTX treated patients had posAR for serotype 6B which was the reason that predictors of positive immune response were studied only for serotype 23F. After adjustment for age and sex in logistic regression model, MTX treatment predicted impaired posAR (p= 0.038; OR 0.5; 95% CI 0.31-0.97) as well as RTX (p<0.001; OR 0.09; 95% CI 0.03-0.3).
Conclusion: MTX and RTX but not TNF-blockers are associated with impaired antibody response following vaccination with heptavalent pneumococcal conjugate vaccine (Prevenar®) in this cohort of patients with established RA. Insufficient statistical power precluded detailed studies of abatacept and tocilizumab on vaccination response.
Disclosure: M. C. Kapetanovic, None; C. Roseman, None; G. Jönsson, None; L. T. Truedsson, None; T. V. Saxne, None; P. Geborek, None.