title: Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases.
abstract: OBJECTIVE
  To present the systematic literature review (SLR), which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases (AIIRD).
  
  
  METHODS
  AIIRD, vaccines and immunomodulating drugs, as well as eight key questions were defined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A SLR was performed using MedLine through October 2009 and including data from meta-analyses, systematic reviews, randomized trials, and observational studies, excluding case series with ≤ 5 participants. Articles in English and regarding patients ≥ 16 years of age, were eligible.
  
  
  RESULTS
  Several vaccine-preventable infections (VPI) occur more often in AIIRD-patients and most vaccines are efficacious in AIIRD-patients, even when treated with immunomodulating agents, except rituximab. There does not appear to be an increase in vaccination-related harms in vaccinated patients with AIIRD in comparison with unvaccinated patients with AIIRD. However, these studies are underpowered and therefore not conclusive.
  
  
  CONCLUSIONS
  Based on the current evidence from the literature, recommendations for vaccination in patients with AIIRD were made. However, more research is needed in particular regarding incidence of VPI, harms of vaccination and the influence of (new and established) immunomodulating agents on vaccination efficacy.
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands. s.van.assen@int.umcg.nl
authors.forename: S
authors.initials: S
authors.lastname: van Assen
authors.forename: O
authors.initials: O
authors.lastname: Elkayam
authors.forename: N
authors.initials: N
authors.lastname: Agmon-Levin
authors.forename: R
authors.initials: R
authors.lastname: Cervera
authors.forename: M F
authors.initials: MF
authors.lastname: Doran
authors.forename: M
authors.initials: M
authors.lastname: Dougados
authors.forename: P
authors.initials: P
authors.lastname: Emery
authors.forename: P
authors.initials: P
authors.lastname: Geborek
authors.forename: J P A
authors.initials: JP
authors.lastname: Ioannidis
authors.forename: D R W
authors.initials: DR
authors.lastname: Jayne
authors.forename: C G M
authors.initials: CG
authors.lastname: Kallenberg
authors.forename: U
authors.initials: U
authors.lastname: Müller-Ladner
authors.forename: Y
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: L
authors.initials: L
authors.lastname: Stojanovich
authors.forename: G
authors.initials: G
authors.lastname: Valesini
authors.forename: N M
authors.initials: NM
authors.lastname: Wulffraat
authors.forename: M
authors.initials: M
authors.lastname: Bijl
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy; D004198:Disease Susceptibility / Q000139:chemically induced / Q000150:complications; D019317:Evidence-Based Medicine; D006801:Humans; D007117:Immunization, Secondary / Q000706:statistics & numerical data; D007155:Immunologic Factors / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000150:complications* / Q000517:prevention & control*; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data; D014612:Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000592:standards
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D014612:Vaccines