Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, Amsterdam, The Netherlands.
Medical Library, Academic Medical Center, Amsterdam, The Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Vaccine. 2018 Sep 18;36(39):5832-5845. doi: 10.1016/j.vaccine.2018.07.039. Epub 2018 Aug 16.
Patients with a weakened immune system due to immunosuppressive treatment are at increased risk of infection with Streptococcus pneumoniae. Although pneumococcal vaccination is highly recommended for those patients, the effectiveness of pneumococcal vaccination in this population remains largely unknown. Therefore, the objective of this PROSPERO-registered systematic review and meta-analysis was to evaluate the effect of the most commonly prescribed immunosuppressive agents such as azathioprine, methotrexate, anti-Tumor Necrosis Factor α (TNFα), or rituximab, on the initial serologic response to pneumococcal vaccination in patients with auto-immune disease.
We included 22 articles comprising 2077 patients, of whom 1623 were treated with immunosuppressive agents, and 454 were controls.
The findings of our systematic review indicate that, in patients treated with immunosuppressive medication and compared to controls, the initial serologic response to pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are impaired. Moreover, this impaired response was more profound after PCV than after PPSV. We hypothesize that the immunosuppressive medication mainly compromises the cellular immunity, explaining the more severely reduced response rate to PCV (which induces a T-cell dependent immune response), compared to PPSV. Treatment with TNFα blocking agents was associated with a more favorable response, compared to patients treated with other immunosuppressive medication. Targeted research applying uniform correlates of protection is needed to bridge the knowledge gap in vaccination immunology in this patient group. PROSPERO registration: CRD42017058364.
由于免疫抑制治疗，免疫系统较弱的患者感染肺炎链球菌的风险增加。尽管强烈建议为这些患者接种肺炎球菌疫苗，但该人群中肺炎球菌疫苗的有效性在很大程度上仍不清楚。因此，本 PROSPERO 注册的系统评价和荟萃分析的目的是评估最常开处方的免疫抑制剂（如硫唑嘌呤、甲氨蝶呤、抗肿瘤坏死因子 α（TNFα）或利妥昔单抗）对自身免疫性疾病患者肺炎球菌疫苗初始血清学反应的影响。
我们纳入了 22 篇文章，共 2077 名患者，其中 1623 名患者接受免疫抑制剂治疗，454 名患者为对照组。
系统评价的结果表明，与对照组相比，接受免疫抑制药物治疗的患者对肺炎球菌结合疫苗（PCV）和肺炎球菌多糖疫苗（PPSV）的初始血清学反应受损。此外，PCV 后的反应受损比 PPSV 更严重。我们假设免疫抑制药物主要损害细胞免疫，这解释了与 PPSV 相比，PCV（诱导依赖 T 细胞的免疫反应）的反应率降低更为严重。与接受其他免疫抑制剂治疗的患者相比，使用 TNFα 阻断剂治疗与更有利的反应相关。需要应用统一的保护相关性来进行靶向研究，以弥合该患者群体中疫苗免疫学知识空白。PROSPERO 注册：CRD42017058364。
