title: Immune response to influenza vaccine and pneumococcal polysaccharide vaccine under IL-6 signal inhibition therapy with tocilizumab.
abstract: OBJECTIVE
  To evaluate humoral immune response to influenza vaccine and polysaccharide pneumococcal vaccine in patients with rheumatoid arthritis (RA) or Castleman's disease (CD) during tocilizumab therapy.
  
  
  METHODS
  Thirty-eight patients (28 RA and 10 CD) receiving tocilizumab and 39 RA patients receiving TNF inhibitors and/or synthetic DMARDs subcutaneously received a single dose of a split-virion inactivated influenza vaccine containing A(New Caledonia (NC):H1N1), A(Hiroshima (HIR):H3N2) and B(Malaysia (MAL)) strains. Twenty-one RA patients using tocilizumab also received 23-valent polysaccharide pneumococcal vaccine. Antibody titers were measured every 4 weeks for a total of 12 weeks after vaccination.
  
  
  RESULTS
  In the tocilizumab group, seroprotective titers (40-fold or more) were obtained in 36/38(95%) for A(NC), 35/38(92%) for A(HIR) and 32/38(84%) for B(MAL). In the patients with baseline antibody titer < 40-fold, 11/11(100%), 7/8(88%) and 18/20(90%) patients showed four-fold or more increase in the titer from baseline to A(NC), A(HIR) and B(MAL), respectively. Patients using TNF inhibitors and/or DMARDs showed similar responses. Pneumococcal antibody titers increased at least two-fold in more than 9 of 12 serotypes, which continued for longer than 12 weeks in all the patients.
  
  
  CONCLUSIONS
  Interleukin-6 (IL-6) blocking therapy with tocilizumab did not affect the humoral immune response to both influenza and pneumococcal vaccines.
authors.affiliation: Medical Co. LTA PS clinic , Fukuoka , Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Tsuru
authors.forename: Kimio
authors.initials: K
authors.lastname: Terao
authors.forename: Miho
authors.initials: M
authors.lastname: Murakami
authors.forename: Takaji
authors.initials: T
authors.lastname: Matsutani
authors.forename: Midori
authors.initials: M
authors.lastname: Suzaki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Amamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Azusa
authors.initials: A
authors.lastname: Akiyama
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishimoto
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D005871:Castleman Disease / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D056724:Immunity, Humoral; D007252:Influenza Vaccines / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology*; D014611:Vaccination
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; C502936:tocilizumab