title: Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease.
abstract: 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.
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, University of California, Los Angeles, California 90048, USA. melmedg@cshs.org
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.forename: Nik
authors.initials: N
authors.lastname: Agarwal
authors.forename: Robert W
authors.initials: RW
authors.lastname: Frenck
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ippoliti
authors.forename: Patricio
authors.initials: P
authors.lastname: Ibanez
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Papadakis
authors.forename: Peter
authors.initials: P
authors.lastname: Simpson
authors.forename: Cristina
authors.initials: C
authors.lastname: Barolet-Garcia
authors.forename: Joel
authors.initials: J
authors.lastname: Ward
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Targan
authors.forename: Eric A
authors.initials: EA
authors.lastname: Vasiliauskas
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D022242:Pneumococcal Vaccines