Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease.
OBJECTIVE
The treatment of inflammatory bowel disease (IBD) often includes immunosuppressive medications, which may increase the risk of vaccine-preventable illnesses. We aimed to assess the impact of immunosuppression on immune responses to pneumococcal vaccination in patients with IBD.


METHODS
The study design consists of a prospective controlled clinical trial. This study was carried out at a tertiary-care IBD clinic. The subjects for the study belonged to one of the following three groups: adult patients with IBD on combination TNF-blockers and immunomodulators (Group A), those without immunosuppressive therapy (Group B), and age-matched healthy controls (Group C). The treatment consisted of immunization with 23-valent pneumococcal polysaccharide vaccines (PSVs). The main outcome was immune response for five serotypes defined as a twofold or greater increase from pre-vaccination titers and > or =1 microg post-vaccination titer.


RESULTS
Sixty-four subjects participated in the study: 20 in Group A, 25 in Group B, and 19 in Group C. Pre-vaccination titers were similar among the three groups. Vaccine responses were lower in Group A than in Group B (P< or =0.01 for four out of five antigens) and Group C (P<0.01 for all five antigens). Overall vaccine response was seen in 45, 80, and 85% of Groups A, B, and C (P=0.01), respectively.


CONCLUSIONS
Immune response to PSV-23 is impaired in Crohn's disease (CD) patients on combination immunosuppressive therapy but is normal among non-immunosuppressed patients. Given the unpredictable likelihood for immunosuppressive therapy, newly diagnosed patients with IBD should undergo vaccination before the initiation of immunosuppressive therapy.
Melmed
Gil Y
GY
Department of Medicine, Cedars-Sinai Medical Center, University of California, Los Angeles, California 90048, USA. melmedg@cshs.org
Agarwal
Nik
N
Frenck
Robert W
RW
Ippoliti
Andrew F
AF
Ibanez
Patricio
P
Papadakis
Konstantinos A
KA
Simpson
Peter
P
Barolet-Garcia
Cristina
C
Ward
Joel
J
Targan
Stephan R
SR
Vasiliauskas
Eric A
EA
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011446:Prospective Studies
D007166:Immunosuppressive Agents; D022242:Pneumococcal Vaccines