A Systematic Review and Metaanalysis of Antirheumatic Drugs and Vaccine Immunogenicity in Rheumatoid Arthritis

Abstract

Antirheumatic drugs may limit humoral responses to vaccination as evidenced by pneumococcal responses with MTX exposure; however, they are safe and should not preclude immunization against vaccine-preventable disease. Vaccination should be considered in all patients with RA and encouraged as part of routine care. (Systematic review registration number: PROSPERO 2016: CRD42016048093.).

Immunization Strategies to Span the Spectrum of Immunocompromised Adults

“…80 In terms of impairing vaccine immunogenicity, prednisone greater than 10 to 20 mg per day and rituximab have the greatest effect on influenza and pneumococcal vaccines in persons with RA. 74,[81][82][83][84] Tumor necrosis factor-a (TNF-a) inhibitors do not appear to affect the immune response to influenza and pneumococcal vaccines in persons with RA. 81 Some studies in persons with inflammatory bowel disease on TNF-a inhibitors have shown decreased antibody titers to hepatitis A, hepatitis B, and influenza vaccines compared with healthy controls.…”

“…74,[81][82][83][84] Tumor necrosis factor-a (TNF-a) inhibitors do not appear to affect the immune response to influenza and pneumococcal vaccines in persons with RA. 81 Some studies in persons with inflammatory bowel disease on TNF-a inhibitors have shown decreased antibody titers to hepatitis A, hepatitis B, and influenza vaccines compared with healthy controls. [85][86][87][88][89] However, most persons achieved seroprotective antibody titers.…”

Mapping Host-Related Correlates of Influenza Vaccine-Induced Immune Response: An Umbrella Review of the Available Systematic Reviews and Meta-Analyses

“…Among the SRs/SRMAs that covered a similar topic, the observed corrected covered areas varied greatly. Indeed, the corrected covered area of three SRMAs on systemic lupus erythematosus [54][55][56] and another three SRMAs on rheumatoid arthritis [47,57,63] showed very high corrected covered areas (73.7% and 21.1%, respectively), while three SRs on cancer patients [46,51,60] and two SRMAs on transplant patients [45,52] showed substantially lower corrected covered areas, which were deemed "moderate" (6.6% and 8.9%, respectively). Table 4 summarizes the evidence synthesis on the effect of any immunosuppressive condition on IV-induced immunogenicity.…”

Vaccination in rheumatology (the 2019 update of EULAR recommendations)

“…К этим вакцинам относятся гриппозные, пневмококковые, противостолбнячные, а также вакцины против гепатитов А/В и ВПЧ. В большинстве работ применение этих вакцин позволяло достичь адекватных уровней иммуногенности при отсутствии новых данных в отношении безопасности, хотя катамнестический период в этих исследованиях был коротким [8][9][10].…”