Pneumococcal infection in patients with systemic lupus erythematosus

Schurder, Juliet; Goulenok, Tiphaine; Jouenne, R.; Dossier, Antoine; Gysel, Damien van; Papo, Thomas; Sacré, Karim

doi:10.1016/j.jbspin.2017.05.012

Cited by 32 publications

(28 citation statements)

References 23 publications

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“…Consistently, data from a Canadian population-based surveillance for IPD showed a substantially increased incidence rate of IPD among patients with SLE, SSc, Sjögren’s syndrome and dermatomyositis/polymyositis (DM/PM) during 1995–2012 19. Two studies focusing in particular on patients with SLE have confirmed the previously reported notion of a substantially high risk of pneumococcal pneumonia and IPD in this susceptible population 20 21. Moreover, case-fatality ratio related to IPD in patients with SLE was higher compared with immunocompetent controls, OR 1.3, 95% CI 0.4 to 4.8 19.…”

Section: Resultssupporting

confidence: 73%

“…In the 2011 review, four studies reported on the incidence of pneumococcal infection in patients with systemic lupus erythematosus (SLE), without comparison to the general population 3. The present literature search yielded seven retrospective cohort studies conducted in the AIIRD population in Europe and USA17–23 (table 2). A large study using the data from USA healthcare claims repositories (2006–2010) identified RA and SLE as risk conditions for both pneumonia and IPD in all age groups 17.…”

Section: Resultsmentioning

confidence: 99%

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Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

et al. 2019

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ObjectivesThe aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available.MethodsA literature search was performed using Medline, Embase and Cochrane library (October 2009 to August 2018). The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate.ResultsSixty-three publications out of 3876 identified records met the inclusion criteria: influenza (n=4), pneumococcal disease (n=7), hepatitis B (n=10), herpes zoster (HZ) (n=29), human papillomavirus (HPV) infection (n=13). An increased incidence of influenza and pneumococcal disease was reported in patients with AIIRD. HZ infection-pooled incidence rate ratio (IRR) was 2.9 (95% CI 2.4 to 3.3) in patients with AIIRD versus general population. Among AIIRD, inflammatory myositis conferred the highest incidence rate (IR) of HZ (pooled IRR 5.1, 95% CI 4.3 to 5.9), followed by systemic lupus erythematosus (SLE) (pooled IRR 4.0, 95% CI 2.3 to 5.7) and rheumatoid arthritis (pooled IRR 2.3, 95% CI 2.1 to 2.6). HPV infection-pooled prevalence ratio was 1.6, 95% CI 0.7 to 3.4 versus general population, based on studies mainly conducted in the SLE population in Latin America and Asia. Pooled prevalence of hepatitis B surface antigen and hepatitis B core antibody in patients with AIIRD was similar to the general population, 3%, 95% CI 1% to 5% and 15%, 95% CI 7% to 26%, respectively.ConclusionCurrent evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.

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Section: Resultssupporting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

et al. 2019

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“…Our data indicate that anti-pneumococcal vaccine Prevnar-13, effectively produces humoral PPS-specific immunity in lupus-prone MRL- lpr mice, while also ameliorating disease severity, a phenomenon associated with reduced T FH cells. Although SLE patients are at increased risk for Streptococcus pneumoniae infection (9, 11), vaccination coverage remains dramatically low (32). Limited data are available regarding efficacy of recommended prime-and-boost strategy using Prevnar-13 in SLE patients, but available evidence indicates that they can generate an effective response, albeit inferior compared to healthy controls (11, 33).…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Polysaccharide Vaccine Ameliorates Murine Lupus

et al. 2019

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Current guidelines encourage administering pneumococcal vaccine Prevnar-13 to patients with lupus, but whether such vaccinations affect disease severity is unclear. To address this issue, we treated 3-month-old MRL-lpr mice, that spontaneously develop a lupus-like syndrome, with Prevnar-13 or vehicle control. After 3 months, we quantified circulating anti-Pneumococcal polysaccharide capsule (PPS) antibodies and signs of disease severity, including albuminuria, renal histology and skin severity score. We also compared immunophenotypes and function of T and B cells from treated and untreated animals. Prevnar-13 elicited the formation of anti-pneumococcal IgM and IgG. Prevnar-13 treated animals showed reduced albuminuria, renal histological lesions, and milder dermatitis compared to vehicle-treated controls. Mitigated disease severity was associated with reduced and increased T follicular helper cells (TFH) and T follicular regulatory cells (TFR), respectively, in Prevnar-treated animals. T cells from Prevnar-13 vaccinated mice showed differential cytokine production after aCD3/aCD28 stimulation, with significantly decreased IL-17 and IL-4, and increased IL-10 production compared to non-vaccinated mice. In conclusion, pneumococcal vaccination elicits anti-pneumococcal antibody response and ameliorates disease severity in MRL-lpr mice, which associates with fewer TFH and increased TFR. Together, the data support use of Prevnar vaccination in individuals with SLE.

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“…SLE patients are, indeed, highly susceptible to S. pneumoniae. Invasive pneumococcal infection has an estimated incidence ranging from 201/100.000 to 236/100,000 patient-years among SLE patients, an incidence 13 times higher with respect to the general population (17,18). Therefore, according to the European League Against Rheumatism (EULAR), vaccination status should be assessed in the initial workup of patients with autoimmune conditions including SLE (19).…”

Section: Introductionmentioning

confidence: 99%