Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan.
Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan.
Mod Rheumatol. 2023 Mar 2;33(2):312-317. doi: 10.1093/mr/roac029.
To evaluate the antibody response to 13-valent pneumococcal conjugate vaccine (PCV13) in patients with rheumatoid arthritis receiving Janus kinase inhibitors (JAKIs).
Fifty-three patients receiving methotrexate (MTX; n = 10), JAKI (n = 20), or MTX + JAKI (n = 23) were vaccinated with PCV13. Serum concentrations of immunoglobulin G (IgG) antibodies to 13 pneumococcal serotype capsular polysaccharides were quantified before and 4-6 weeks after vaccination. Positive antibody response was defined as a 2-fold or more increase in IgG concentrations from prevaccination levels.
After vaccination, IgG concentrations significantly increased in all treatment groups (P <0.001), but fold increases (postvaccination to prevaccination ratios) were different among treatment groups (9.30 for MTX, 6.36 for JAKI, and 3.46 for combination therapy). Positive antibody response rates were comparable between the MTX group (90%) and the JAKI group (95%) but lower in the MTX + JAKI group (52.2%). In a multivariable logistic regression analysis, the combination therapy was the only factor associated with a reduced antibody response to PCV13. No severe adverse events were observed in any treatment group.
Although JAKIs do not impair PCV13 immunogenicity in rheumatoid arthritis patients, the combination of MTX with JAKI can reduce the antibody response in this patient population.
评估接受 Janus 激酶抑制剂（JAKI）治疗的类风湿关节炎患者对 13 价肺炎球菌结合疫苗（PCV13）的抗体应答。
53 例接受甲氨蝶呤（MTX；n=10）、JAKI（n=20）或 MTX+JAKI（n=23）治疗的患者接种了 PCV13。在接种前和接种后 4-6 周，定量检测血清中针对 13 种肺炎球菌荚膜多糖的免疫球蛋白 G（IgG）抗体浓度。阳性抗体应答定义为 IgG 浓度比接种前水平增加 2 倍或以上。
接种后，所有治疗组的 IgG 浓度均显著增加（P<0.001），但治疗组之间的倍数增加（接种后与接种前的比值）不同（MTX 组为 9.30，JAKI 组为 6.36，联合治疗组为 3.46）。MTX 组（90%）和 JAKI 组（95%）的阳性抗体应答率相当，但 MTX+JAKI 组（52.2%）较低。在多变量逻辑回归分析中，联合治疗是唯一与 PCV13 抗体应答降低相关的因素。在任何治疗组均未观察到严重不良事件。
尽管 JAKI 不会损害类风湿关节炎患者对 PCV13 的免疫原性，但 MTX 与 JAKI 的联合使用可能会降低该患者人群的抗体应答。
