Funded by an unrestricted grant by the Lombardy Association of IBD patients (A.M.I.C.I. Lombardia).
Effects of immunosuppression on immune response to pneumococcal vaccine in inflammatory bowel disease: A prospective study†
Article first published online: 14 JUN 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 6, pages 1042–1047, June 2012
How to Cite
Fiorino, G., Peyrin-Biroulet, L., Naccarato, P., Szabò, H., Sociale, O. R., Vetrano, S., Fries, W., Montanelli, A., Repici, A., Malesci, A. and Danese, S. (2012), Effects of immunosuppression on immune response to pneumococcal vaccine in inflammatory bowel disease: A prospective study. Inflamm Bowel Dis, 18: 1042–1047. doi: 10.1002/ibd.21800
- Issue published online: 17 MAY 2012
- Article first published online: 14 JUN 2011
- Manuscript Accepted: 18 MAY 2011
- Manuscript Received: 17 MAY 2011
- Crohn's disease;
- ulcerative colitis;
- inflammatory bowel disease;
Since immunomodulators and antitumor necrosis factor (TNF) agents are increasingly used to treat inflammatory bowel disease (IBD), it is recommended to administer antipneumococcal vaccination to prevent opportunistic pneumonia. There is some evidence that concomitant immunosuppression may impair the immune response to vaccination. We aimed to evaluate the response rates to pneumococcal vaccination in four different treatment groups (mesalamine, azathioprine, infliximab, infliximab plus azathioprine).
In all, 96 patients with IBD (54 with Crohn's disease; 42 with ulcerative colitis) were administered a 23-valent polysaccharide pneumococcal vaccine (PSV-23). The levels of antipneumococcal antibodies were measured prior to and at least 3 weeks after vaccination. Response rates and risk factors for impaired immunosuppression were investigated. Patients on mesalamine were used as a control group.
Patients administered infliximab or the combination immunosuppressive therapy had significantly lower response rates to vaccination (57.6% and 62.5%, respectively) compared with the group on mesalamine (88.6%; P < 0.05 for both comparisons). Azathioprine alone did not influence the response rate to vaccination (78.9%; P = 0.43 vs. mesalamine group). Mean antibody titers after vaccination were significantly lower in patients under infliximab or combined immunosuppression than controls (P < 0.05). Immunosuppression with infliximab or combination therapy significantly decreased the likelihood of responding to vaccination (odds ratio [OR] = 0.17, 95% confidence interval [CI] 0.04–0.64, P = 0.009, and OR = 0.21, 95% CI 0.05–0.91, P = 0.038, respectively). Pneumococcal vaccination was generally safe and well tolerated.
Anti-TNF therapy alone or in combination with azathioprine impairs the response to pneumococcal vaccination in patients with IBD. All patients with IBD should therefore be vaccinated before starting anti-TNF therapy. (Inflamm Bowel Dis 2012;)