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Antirheumatic drugs may reduce humoral response to vaccination

07 Jun 2018
The pharmacist’s role in promoting immunisation programmes

Pneumococcal responses with methotrexate (MTX) exposure show that antirheumatic drugs may limit humoral responses to vaccination, but such treatment remains safe and must not prevent immunization against vaccine-preventable disease, according to the results of a systematic review and meta-analysis.

“Vaccination should be considered in all patients with rheumatoid arthritis (RA) and encouraged as part of routine care,” the authors said.

The meta-analysis included nine studies (seven studies investigating antirheumatic drug exposures and influenza humoral response and two studies investigating pneumococcal vaccine response).

There were sustained responses of the influenza vaccine to all subunit strains (H1N1, H3N2, B strain) with MTX and tumour necrosis factor inhibitor (TNFi) drug exposure. However, pneumococcal vaccine response to 6B and 23F was reduced with MTX but not TNFi drug exposure (risk ratio [RR], 0.42; 95 percent CI, 0.28–0.63 vs RR, 0.98; 0.58–1.67).

Available data were limited to draw any firm conclusions regarding this finding, the authors said.

In addition, combination of MTX and tocilizumab or tofacitinib correlated with reduced pneumococcal and influenza vaccine responses.

A systematic review and meta-analysis was conducted comparing the humoral response to influenza (pandemic and seasonal trivalent subunit vaccines) and pneumococcal (23-valent pneumococcal polysaccharide vaccine, 7- and 13-valent pneumococcal conjugated vaccines) vaccination in adult patients with RA treated with antirheumatic drugs. Vaccine immunogenicity was evaluated by seroprotection rates measured 3–6 weeks postimmunization.

“Vaccination is a key strategy to reduce infection risk in patients with RA and is advocated in internationally recognized rheumatology society guidelines,” the authors said.

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