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Anti-TNF-Alpha Therapy May Interfere With Pneumococcal Vaccination: Presented at CHEST

By Alison Palkhivala
Special to DG News

SAN DIEGO, CA -- November 7, 2002 -- Treatment with anti-tumour necrosis factor a (TNFa) drugs may interfere with pneumococcal vaccination.

The finding was presented here November 5 at the annual meeting of the American College of Chest Physicians (CHEST).

As a result, patients being initiated on such therapy should be vaccinated before they start, say Jeffrey B. Rubins, MD, from the pulmonary division, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, United States.

Anti-TNFa drugs are promising agents for the treatment of autoimmune diseases such as rheumatoid arthritis. However, these therapies may place patients at increased risk for bacterial infections and may interfere with vaccinations designed to prevent such infections.

Dr. Rubins and colleagues examined the effect that a 0.5 mL injection of a pneumococcal vaccine had on 16 patients being treated with the anti-TNFa drugs infliximab or etanercept for the treatment of rheumatoid arthritis or ankylosing spondylitis, 42 patients with rheumatoid arthritis taking immunosuppressive agents other than anti-TNFa drugs and 20 healthy controls.

They used enzyme linked immunosorbent assay (ELISA) to test patients' serum levels of pneumococcal polysaccharide (PPS)-specific IgG to seven vaccine PPSs one month after vaccination. Prior to vaccination, antibody levels to the seven pneumococcal serotypes were similar among the three groups of patients.

One month after immunisation, all patients had increases in their levels of capsule PPS antibodies and antibodies to all seven serotypes, compared with pre-vaccination levels.

Patients taking anti-TNFa drugs tended to have lower antibody increases for all the serotypes but one. Also, 12 to 56 percent of patients taking anti-TNFa drugs responded to pneumococcal vaccination compared to 35 to 71 percent of patients taking other immunosuppressive drugs and 55 to 95 percent of healthy controls. Also, a greater proportion of patients taking anti-TNFa drugs were poor responders to the vaccine, which was defined as showing two-fold responses to fewer than two of seven vaccine serotypes.

According to Dr. Rubins, "treatment of groups of patients with etanercept or infliximab does not impair their main antibody response to pneumococcal vaccination. However, a large proportion of our patients may not respond adequately to pneumococcal vaccination once on TNFa blockage therapies. Consequently, pneumococcal vaccination prior to starting TNFa blockade therapy is recommended."

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