使用免疫抑制药物患者的甲型肝炎疫苗免疫原性：一项系统评价和荟萃分析。

Hepatitis A vaccine immunogenicity in patients using immunosuppressive drugs: A systematic review and meta-analysis.

作者信息

Garcia Garrido Hannah M, Veurink Ati M, Leeflang Mariska, Spijker René, Goorhuis Abraham, Grobusch Martin P

机构信息

Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands.

出版信息

Travel Med Infect Dis. 2019 Nov-Dec;32:101479. doi: 10.1016/j.tmaid.2019.101479. Epub 2019 Sep 12.

DOI:10.1016/j.tmaid.2019.101479

PMID:31521804

Abstract

INTRODUCTION

Inactivated hepatitis A (HepA) vaccines are very immunogenic in healthy individuals; however, it remains unclear how different immunosuppressive regimens affect HepA vaccine immunogenicity. Our objective was to summarise the current evidence on immunogenicity of HepA vaccination in patients using immunosuppressive drugs.

METHODS

We systematically searched the literature for studies on immunogenicity of inactivated HepA vaccines in adults using immunosuppressive drugs. Studies reporting seroconversion rates (SCR) 4-8 weeks after 1 and 2 doses of HepA vaccine in organ transplant recipients and patients with chronic inflammatory conditions were included in a meta-analysis.

RESULTS

We included 17 studies, comprising 1,332 individuals. In healthy controls (2 studies), SCRs were 90-94% after the first dose and 100% after the second dose. In organ transplant recipients, SCRs ranged from 0 to 67% after the first dose of vaccine and 0-97% after the second dose. In patients with chronic inflammatory conditions, SCRs ranged from 6% to 100% after the first dose and from 48 to 100% after the second dose of vaccine. Patients using a TNF-alpha inhibitor versus conventional immune-modulators (e.g. methotrexate, azathioprine, corticosteroids) were more likely to seroconvert after the first dose of vaccine (OR12.1 [2.14-68.2]) but not after the second dose of vaccine (OR 0.78 [0.21-2.92]) in a meta-analysis.

CONCLUSION

Studies evaluating HepA vaccine immunogenicity in immunosuppressive agents are heterogeneous. Overall, there is an impaired immune response following HepA vaccination in patients using immunosuppressive drugs, especially after only one dose of vaccine and in organ transplant recipients. HepA vaccination should therefore be considered before immunosuppressive therapy. Future research should focus on alternative vaccination regimens and long-term immunogenicity.

PROSPERO ID

CRD42018102607.

摘要

引言

灭活甲型肝炎（HepA）疫苗在健康个体中具有很强的免疫原性；然而，不同的免疫抑制方案如何影响HepA疫苗的免疫原性仍不清楚。我们的目的是总结目前关于使用免疫抑制药物的患者接种HepA疫苗免疫原性的证据。

方法

我们系统检索了关于使用免疫抑制药物的成年人接种灭活HepA疫苗免疫原性的研究文献。纳入了报告器官移植受者和慢性炎症性疾病患者在接种1剂和2剂HepA疫苗后4 - 8周血清转化率（SCR）的研究进行荟萃分析。

结果

我们纳入了17项研究，共1332人。在健康对照者（2项研究）中，首剂疫苗后SCR为90% - 94%，第2剂后为100%。在器官移植受者中，首剂疫苗后SCR范围为0至67%，第2剂后为0至97%。在慢性炎症性疾病患者中，首剂疫苗后SCR范围为6%至100%，第2剂疫苗后为48%至100%。在一项荟萃分析中，与使用传统免疫调节剂（如甲氨蝶呤、硫唑嘌呤、皮质类固醇）相比，使用肿瘤坏死因子-α抑制剂的患者在首剂疫苗后更有可能发生血清转化（比值比12.1 [2.14 - 68.2]），但在第2剂疫苗后则不然（比值比0.78 [0.21 - 2.92]）。