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Clinical and epidemiological research
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Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tocilizumab therapy
  1. Shunsuke Mori1,
  2. Yukitaka Ueki2,
  3. Yukihiro Akeda3,
  4. Naoyuki Hirakata2,
  5. Motohiro Oribe4,
  6. Yoshiki Shiohira5,
  7. Toshihiko Hidaka6,
  8. Kazunori Oishi7
  1. 1Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, Kohshi, Kumamoto, Japan
  2. 2Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
  3. 3Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
  4. 4Oribe Rheumachika-Naika Clinic, Oita, Oita, Japan
  5. 5Department of Internal Medicine, Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan
  6. 6Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Miyazaki, Japan
  7. 7Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Shinjyuku-ku, Tokyo, Japan
  1. Correspondence to Shunsuke Mori, Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan; moris{at}saisyunsou1.hosp.go.jp

Abstract

Objectives We assessed the impact of tocilizumab (TCZ), a humanised monoclonal anti-interleukin-6 receptor antibody, on antibody response following administration of the 23-valent pneumococcal polysaccharide vaccine (PPV23).

Methods A total of 190 patients with rheumatoid arthritis (RA) received PPV23. Patients were classified into TCZ (n=50), TCZ + methotrexate (MTX) (n=54), MTX (n=62) and RA control (n=24) groups. We measured serotype-specific IgG concentrations of pneumococcal serotypes 6B and 23F using ELISA and functional antibody activity using a multiplexed opsonophagocytic killing assay, reported as the opsonisation indices (OIs), before and 4–6 weeks after vaccination. Positive antibody response was defined as a 2-fold or more increase in the IgG concentration or as a ≥10-fold or more increase in the OI.

Results IgG concentrations and OIs were significantly increased in all treatment groups in response to vaccination. The TCZ group antibody response rates were comparable with those of the RA control group for each serotype. MTX had a negative impact on vaccine efficacy. Multivariate logistic analysis confirmed that TCZ is not associated with an inadequate antibody response to either serotype. No severe adverse effect was observed in any treatment group.

Conclusions TCZ does not impair PPV23 immunogenicity in RA patients, whereas antibody responses may be reduced when TCZ is used as a combination therapy with MTX.

  • Methotrexate
  • Rheumatoid Arthritis
  • Vaccination
  • Infections

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/annrheumdis-2012-202658

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