Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tocilizumab therapy.
OBJECTIVE
We assessed the impact of tocilizumab (TCZ), a humanised monoclonal anti-interleukin-6 receptor antibody, on antibody response following administration of the 23-valent pneumococcal polysaccharide vaccine (PPV23).


METHODS
A total of 190 patients with rheumatoid arthritis (RA) received PPV23. Patients were classified into TCZ (n=50), TCZ + methotrexate (MTX) (n=54), MTX (n=62) and RA control (n=24) groups. We measured serotype-specific IgG concentrations of pneumococcal serotypes 6B and 23F using ELISA and functional antibody activity using a multiplexed opsonophagocytic killing assay, reported as the opsonisation indices (OIs), before and 4-6 weeks after vaccination. Positive antibody response was defined as a 2-fold or more increase in the IgG concentration or as a ≥10-fold or more increase in the OI.


RESULTS
IgG concentrations and OIs were significantly increased in all treatment groups in response to vaccination. The TCZ group antibody response rates were comparable with those of the RA control group for each serotype. MTX had a negative impact on vaccine efficacy. Multivariate logistic analysis confirmed that TCZ is not associated with an inadequate antibody response to either serotype. No severe adverse effect was observed in any treatment group.


CONCLUSIONS
TCZ does not impair PPV23 immunogenicity in RA patients, whereas antibody responses may be reduced when TCZ is used as a combination therapy with MTX.
Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, Kohshi, Kumamoto, Japan. moris@saisyunsou1.hosp.go.jp
Shunsuke
S
Mori
Yukitaka
Y
Ueki
Yukihiro
Y
Akeda
Naoyuki
N
Hirakata
Motohiro
M
Oribe
Yoshiki
Y
Shiohira
Toshihiko
T
Hidaka
Kazunori
K
Oishi
D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000917:Antibody Formation / Q000187:drug effects*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D009895:Opsonin Proteins / Q000276:immunology; D010587:Phagocytosis / Q000276:immunology; D022242:Pneumococcal Vaccines / Q000276:immunology; D011135:Polysaccharides, Bacterial / Q000097:blood / Q000276:immunology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000276:immunology
D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D009895:Opsonin Proteins; D022242:Pneumococcal Vaccines; D011135:Polysaccharides, Bacterial; C502936:tocilizumab; D008727:Methotrexate
Infections; Methotrexate; Rheumatoid Arthritis; Vaccination