Patients with Crohn's disease on anti-tumor necrosis factor therapy are at significant risk of inadequate response to the 23-valent pneumococcal polysaccharide vaccine

Chang Kyun Lee, Hyun Soo Kim, Byong Duk Ye, Kang Moon Lee, You Sun Kim, Sang Youl Rhee, Hyo Jong Kim, Suk Kyun Yang, Won Moon, Ja Seol Koo, Suck Ho Lee, Geom Seog Seo, Soo Jung Park, Chang Hwan Choi, Sung Ae Jung, Sung Noh Hong, Jong Pil Im, Eun Soo Kim

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28 Citations (Scopus)

Abstract

Background/aims: The effect of immunosuppressants on the efficacy of a variety of vaccines is a controversial issue in patients with inflammatory bowel disease (IBD). In this study we determined whether specific immunosuppressants impair the serological response to the standard 23-valent pneumococcal polysaccharide vaccine (PPSV23) in a large cohort of patients with Crohn's disease (CD). Methods: This was a multi-center, prospective observational study of adult patients with CD at 15 academic teaching hospitals in Korea. The study population received one intramuscular injection of PPSV23. Anti-pneumococcal IgG antibody titers were measured by immunoassay prior to and 4. weeks after vaccination. All vaccination-related adverse events and the effect of the vaccine on disease activity were also evaluated. Results: The overall serological response rate was 67.5% (133/197). The serological response rate was significantly lower in patients on anti-tumor necrosis factor (anti-TNF) therapy (50.0% on anti-TNF alone 58.0% on anti-TNF combined with an immunomodulator, IM) than patients on 5-aminosalicylate (78.4%; all P-values vs. 5-aminosalicylate. <. 0.05); 45.6% (41/90) of patients on anti-TNF therapy were not protected against PPSV23. IM did not affect the immunologic response to the vaccine. Female gender and anti-TNF therapy were significant predictors of non-response to the vaccine (odds ratio [OR] 2.316, P= 0.015; OR 2.582, P= 0.048, respectively). Vaccination was generally safe and tolerated by all patients. Conclusions: Patients with CD on anti-TNF therapy are at significant risk of an inadequate response to PPSV23. The pneumococcal vaccination strategy should be optimized for patients with CD on anti-TNF therapy.

Original languageEnglish
Pages (from-to)384-391
Number of pages8
JournalJournal of Crohn's and Colitis
Volume8
Issue number5
DOIs
Publication statusPublished - 2014 May 1

Keywords

  • Crohn's disease
  • Immunosuppressive agents
  • Inflammatory bowel disease
  • Pneumococcal vaccine

ASJC Scopus subject areas

  • Gastroenterology

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    Lee, C. K., Kim, H. S., Ye, B. D., Lee, K. M., Kim, Y. S., Rhee, S. Y., Kim, H. J., Yang, S. K., Moon, W., Koo, J. S., Lee, S. H., Seo, G. S., Park, S. J., Choi, C. H., Jung, S. A., Hong, S. N., Im, J. P., & Kim, E. S. (2014). Patients with Crohn's disease on anti-tumor necrosis factor therapy are at significant risk of inadequate response to the 23-valent pneumococcal polysaccharide vaccine. Journal of Crohn's and Colitis, 8(5), 384-391. https://doi.org/10.1016/j.crohns.2013.09.022