Background The guidelines for the management of rheumatoid arthritis (RA) recommend an annual influenza vaccine and a pneumonia vaccination (EULAR, 2011), prior to starting disease-modifying anti-rheumatic drug (DMARD) therapy. The proportion of patients with RA in the UK receiving these vaccinations, and the timing of vaccinations in relation to starting DMARD therapy, is not clear.
Objectives To measure the extent to which patients with RA are vaccinated in the UK, and to determine the timing of the vaccinations in relation to starting DMARD therapy.
Methods This was a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD). An inception cohort of patients, aged 18 years and over, who were diagnosed with RA and were prescribed DMARD therapy during follow-up (1st January 2000 – 31st December 2013) were identified. Vaccination status was considered as follows: 1) Influenza: The influenza season was estimated to start on 1st September each year and all patients were considered unvaccinated at this point. Patients were considered vaccinated if they received an influenza vaccine between 1st September and 31st March the following year. 2) Pneumonia: Following vaccination patients were considered vaccinated for the rest of follow-up. For both influenza and pneumonia vaccines, descriptive statistics show 1) the proportion having at least one vaccination, 2) the observed and expected use and 3) the proportion of first vaccinations occurring prior to DMARD therapy initiation. Patients were divided into those above or below 65 at the start of follow-up, given differences in vaccination guidelines for the general population.
Results There were 17,877 patients with RA identified who were treated with DMARD therapy during follow-up.
Age below 65 years (N=11391): 8299 (73%) patients had received at least one influenza vaccination, of whom 2968 (36%) were vaccinated prior to starting DMARD therapy. On average 64% of expected vaccinations were received. Of those expected to have up to 5 vaccinations, 20% - 30% received all expected vaccinations. There were 4960 (44%) patients who had received at least one pneumonia vaccination, of whom 1269 (26%) were vaccinated prior to starting DMARD therapy.
Age 65 years and over (N=6486): 5851 (90%) patients received at least one influenza vaccination, of whom 4549 (78%) were vaccinated prior to starting DMARD therapy. On average 86% of expected vaccinations were received. Of those expected to have up to 5 vaccinations, 55%>75% received all expected vaccinations. There were 4026 (62%) patients who received at least one pneumonia vaccination, of whom 2498 (62%) received a vaccination prior to starting DMARD therapy (Table 1).
Conclusions Overall uptake of vaccinations for influenza was greater than uptake of vaccinations for pneumonia. Patient's aged below 65 years were vaccinated less than those who were aged 65 years or over. Many patients were not vaccinated before initiating DMARD therapy, especially if they were younger.
Disclosure of Interest None declared
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