398 - Rituximab and Methotrexate but Not TNF-Blockers Are Associated with Impaired Antibody Response Following Pneumococcal Vaccination Using 7-Valent Conjugate Vaccine (Prevenar®) In Patients with Established Rheumatoid Arthritis

Sunday, November 6, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Meliha C. Kapetanovic1, Carmen Roseman1, Göran Jönsson2, Lennart T. Truedsson3, Tore V. Saxne1 and Pierre Geborek1, 1Dept of Clinical Sciences Lund, Section of Rheumatology, Lund, Sweden, 2Dept of Clinical Sciences Lund, Section of Infectious Diseases, Lund, Sweden, 3Dept of Clinical Sciences Lund, Section of Microbiology, Immunology and Glycobiology, Lund, Sweden
Presentation Number: 398

Background/Purpose: To investigate the impact of anti-rheumatic treatments including methotrexate (MTX), TNF blockers, rituximab (RTX), abatacept and tocilizumab on antibody response following pneumococcal vaccination using 7-valent conjugate vaccine (Prevenar®) in patients with established RA.

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.


Keywords: antibody microarray, rheumatoid arthritis (RA), spondylarthropathy and vaccines

Disclosure: M. C. Kapetanovic, None; C. Roseman, None; G. Jönsson, None; L. T. Truedsson, None; T. V. Saxne, None; P. Geborek, None.