Recommendations for prevention of infection in systemic autoimmune rheumatic diseases

Larrinoa, Iñigo Rúa-Figueroa Fernández de; Carreira, Patrícia; García, Noé Brito; Fontecha, Petra Díaz del Campo; Reigosa, José María Pego; Gómez-Puerta, José A.; Ortega‐Castro, Rafaela; Segura, Beatriz Tejera; García, Jesús Rodríguez; Torre‐Cisneros, Julián; Valencia-Martín, José Lorenzo; Pereda, Claudia Alejandra; Nishishinya-Aquino, María Betina; Sánchez, María Teresa Otón; Fernández, Lucía Silva; Maese, Jesús; Carmona, Eugenio Chamizo; Plaza, María Correyero

doi:10.1016/j.reumae.2021.04.003

Cited by 3 publications

(2 citation statements)

References 142 publications

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“…3 HBV vaccination is thus recommended for non-immunised patients with inflammatory arthritides (IA), in particular those at risk, starting bDMARDs. [4][5][6] There is some evidence that HBV vaccination is effective in patients under conventional synthetic diseasemodifying antirheumatic drugs (csDMARDs) (68%-95% seroprotection 7 8 vs >85% in healthy adults 9 ), but it is currently unclear whether this also applies to bDMARDs, with little and conflicting evidence available. [10][11][12][13] We therefore aimed to assess the efficacy and safety of HBV vaccination in patients with IA treated with bDMARDs.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics

Romão,

Ávila-Ribeiro,

Gonçalves

et al. 2023

RMD Open

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BackgroundHepatitis B virus (HBV) vaccination is recommended for non-immunised patients with rheumatic diseases starting biological disease-modifying antirheumatic drugs (bDMARDs). There is some evidence that HBV vaccination is effective in patients under conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), but it is currently unclear whether this also applies to bDMARDs.ObjectivesTo assess the efficacy and safety of HBV vaccination in patients with inflammatory arthritides treated with bDMARDs.MethodsA prospective cohort with inflammatory arthritides treated with bDMARDs, negative for anti-HBs and anti-HBc and never vaccinated for HBV was recruited. Engerix B was administered at 0, 1 and 6 months and anti-HBs was reassessed ≥1 month after last dose. Response was defined as anti-HBs≥10 IU/L and compared against vaccinated healthy controls. Disease flare, serious adverse events and immune-related disorders not previously present were recorded.Results62 patients, most treated with TNF inhibitors (TNFi), and 38 controls were recruited. Most patients were taking csDMARDs (67.7%) and were in remission/low disease activity (59.4%). Only 20/62 patients (32.3%) had a positive response to vaccination, in comparison to 36/38 age-matched controls (94.7%, p<0.001). Response was seen in 19/51 patients treated with TNFi (37.3%) and in 1/11 (9.1%) patients treated with non-TNFi (p=0.07), including 1/6 treated with tocilizumab (16.7%). Among TNFi, response rates ranged from 4/22 (18.2%) for infliximab to 8/14 (57.1%) for etanercept. No relevant safety issues were identified.ConclusionsHBV vaccination response in patients with rheumatic diseases treated with bDMARDs was poorer than expected. Our data reinforce the recommendation for vaccination prior to starting bDMARDs.

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Section: Introductionmentioning

confidence: 99%

Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics

Romão,

Ávila-Ribeiro,

Gonçalves

et al. 2023

RMD Open

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“…This group of conditions encompasses a diverse set of rare diseases that often require immunosuppressive or immunomodulatory therapy. However, recommendations for PCP prophylaxis have been scarce, were only recently established [37][38][39], and are subject to debate [40], in contrast to the well-established guidelines for hematologic or solid organ malignancies and transplant recipients [41][42][43][44][45][46][47]. These findings collectively suggest a need for more systematic consideration of PCP antibiotic prophylaxis in these patient populations.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Kamel,

Boulain

2024

Ann. Intensive Care

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Purpose The recent epidemiology of Pneumocystis pneumonia (PCP) requiring intensive care unit (ICU) admission and the associated spectrum of immunocompromising conditions are poorly described. Methods We analyzed all adult PCP cases admitted to French ICUs via the French medical database system (PMSI), over the period from 2013 to 2019. Results French ICUs admitted a total of 4055 adult patients with PCP. Among all hospitalized PCP cases, the proportion requiring ICU admission increased from 17.8 in 2014 to 21.3% in 2019 (P < 0.001). The incidence of severe PCP rose from 0.85 in 2013 to 1.32/100,000 adult inhabitants in 2019 (P < 0.0001), primarily due to the proportion of HIV-negative patients that increased from 60.6% to 74.4% (P < 0.0001). Meanwhile, the annual number of severe PCP cases among patients with HIV infection remained stable over the years. In-hospital mortality of severe PCP cases was 28.5% in patients with HIV infection and 49.7% in patients without. Multivariable logistic analysis showed that patients with HIV infection had a lower adjusted risk of death than patients without HIV infection (Odds Ratio [OR]: 0.30, 95% confidence interval [95CI]: 0.17–0.55). Comorbidities or conditions strongly associated with hospital mortality included the patient’s age, Simplified Acute Physiologic Score II, congestive heart failure, coagulopathy, solid organ cancer, and cirrhosis. A vast array of autoimmune inflammatory diseases affected 19.9% of HIV-negative patients. Conclusions The number of PCP cases requiring ICU admission in France has risen sharply. While the yearly count of severe PCP cases in HIV-infected patients has remained steady, this rise predominantly affects cancer patients, with a recent surge observed in patients with autoimmune inflammatory diseases, affecting one in five individuals.

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Expert consensus on the use of systemic glucocorticoids for managing eosinophil-related diseases

del Pozo,

Bobolea,

Rial

et al. 2024

Front. Immunol.

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Eosinophil-related diseases represent a group of pathologic conditions with highly heterogeneous clinical presentation and symptoms ranging from mild to critical. Both systemic and localized forms of disease are typically treated with glucocorticoids. The approval of novel biologic therapies targeting the interleukin-5 pathway can help reduce the use of systemic glucocorticoids (SGC) in eosinophilic diseases and reduce the risk of SGC-related adverse effects (AEs). In this article, a panel of experts from different medical specialties reviewed current evidence on the use of SGC in two systemic eosinophilic diseases: Eosinophilic Granulomatosis with PolyAngiitis (EGPA) and HyperEosinophilic Syndrome (HES); and in two single-organ (respiratory) eosinophilic diseases: Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) and Severe Asthma with Eosinophil Phenotype (SA-EP), and contrasted it with their experience in clinical practice. Using nominal group technique, they reached consensus on key aspects related to the dose and tapering of SGC as well as on the initiation of biologics as SGC-sparing agents. Early treatment with biologics could help prevent AEs associated with medium and long-term use of SGC.

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Recommendations for prevention of infection in systemic autoimmune rheumatic diseases

Cited by 3 publications

References 142 publications

Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics

Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Expert consensus on the use of systemic glucocorticoids for managing eosinophil-related diseases

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