Rituximab and abatacept but not tocilizumab impair antibody response to pneumococcal conjugate vaccine in patients with rheumatoid arthritisReportar como inadecuado

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Arthritis Research and Therapy

, 15:R171

First Online: 30 October 2013Received: 22 March 2013Accepted: 10 October 2013


IntroductionThe objective of the study was to investigate the impact of newer biologic treatments including rituximab, abatacept and tocilizumab on antibody response following pneumococcal vaccination using a 7-valent conjugate vaccine in patients with established rheumatoid arthritis RA.

MethodsPatients with RA receiving rituximab, abatacept or tocilizumab as monotherapy or combined with methotrexate MTX participated in the study. Specific IgG antibodies against 23F and 6B serotypes were measured at vaccination and 4 to 6 weeks after vaccination using standardised ELISA. Geometric mean antibody levels GML were calculated. Antibody response AR was defined as the ratio between post- and pre-vaccination antibody levels and a positive antibody response posAR was AR ≥2.

ResultsIn total, 88 patients were enrolled in the study. Of 55 patients treated with rituximab, 26 46% were on concomitant MTX. Of patients receiving abatacept n = 17 and tocilizumab n = 16 biologic treatment was given in combination with MTX in 13 76% and 9 56% patients, respectively. Patients treated with rituximab had significantly lower AR compared to those on tocilizumab, as well as compared to previously reported RA patients on MTX and controls spondylarthropathy patients treated with NSAIDs and-or analgesics. In total, 10.3% of patients on rituximab monotherapy and no patient on rituximab + MTX had posAR for both serotypes. For abatacept and tocilizumab the corresponding figures were 17.6% and 50%.

ConclusionIn this cohort of patients with established RA, treatment with rituximab and abatacept was associated with diminished antibody response but this was most pronounced for rituximab. Pneumococcal conjugate vaccine administrated during ongoing tocilizumab treatment seems to be associated with sufficient antibody response. Pneumococcal vaccination should preferably be encouraged before initiation of rituximab or abatacept treatment.

Trial registrationNCT00828997 and EudraCT EU2007-006539-29.

AbbreviationsAnti-CCPAnti-cyclic citrullinated peptide

ARAntibody response

DASDisease activity score

GMLGeometric mean antibody levels

HAQHealth assessment questionnaire



IPDInvasive pneumococcal disease


NSAIDNon-steroidal anti-inflammatory drug

posARPositive antibody response

RARheumatoid arthritis


TNFTumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4358 contains supplementary material, which is available to authorized users.

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Autor: Meliha Crnkic Kapetanovic - Tore Saxne - Göran Jönsson - Lennart Truedsson - Pierre Geborek

Fuente: https://link.springer.com/

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