Background Streptococcus pneumoniae is the most common cause of pneumonia. Prevenar 13, a conjugated vaccine has been developed and has been widely used int he adult population due to its high immunogenicity. In the general population, its efficacy has been proven at all ages, however, little information has become available regarding the efficacy of Prevenar 13 in biologic-treated rheumatoid arthritis (RA) patients.
Objectives Immunogenicity of Prevenar 13 was assessed in a cohort of RA patients treated with etanercept.
Methods In this prospective study, 22 RA patients already treated with weekly 50mg sc etanercept in combination with methotrexate (n=15) or in monotherapy (n=7) for at least one year were included (mean age 55.1 years). Altogether 24 osteoarthritis patients not receiving biological therapy served as controls (mean age 63.9 years). Prevenar 13 vaccination was performed in all RA patients (±5 days before/after etanercept treatment) and controls and Pneumococcus antibody levels were assessed at baseline, as well as 4 and 8 weeks after vaccination.
Results At baseline, Pneumococcus antibody levels in RA patients and in controls were 110.1±68.2 mg/l and 124.0±99.0 mg/l, respectively. Four weeks after vaccination, antibody levels significantly increased in both groups (RA: 247.7±155.6 mg/l; controls: 417.7±198.3 mg/l vs baseline) (p<0.001). There was significant difference between the two groups (p=0.002). At week 8, antibody levels somewhat decreased in both groups, however, still remained significantly higher compared to baseline (RA: 207.6±127.6 mg/l; control: 356.4±171.2 mg/l) (p<0.001). In RA, increases in antibody levels at week 8 compared to baseline exerted a negative correlation with age (Spearman's R=-0,431; p=0.045). Combination with methotrexate had no effect on pPneumococcus antibody levels as compared to patients treated with etanercept monotherapy.
Conclusions In RA patients treated with etanercept, vaccination with Prevenar 13 is effective, resulting in a two-fold increase in Pneumococcus antibody levels. The efficacy of Prevenar 13 vaccination may be more pronounced in younger patients.
Disclosure of Interest None declared
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