Humoral immune response to vaccines in patients with rheumatoid arthritis treated with tocilizumab: results of a randomised controlled trial (VISARA).
OBJECTIVE
To evaluate the effect of tocilizumab (TCZ), an interleukin 6 receptor inhibitor, on humoral immune responses to immunisations in patients with rheumatoid arthritis (RA).


METHODS
Patients with RA with inadequate response/intolerance to one or more anti-tumour necrosis factor-α agents were randomly assigned (2:1) to TCZ 8 mg/kg intravenously every 4 weeks plus methotrexate (MTX) or MTX alone up until week 8. Serum was collected before vaccination at week 3, antibody titres were evaluated at week 8, and then all patients received TCZ+MTX through week 20. End points included proportion of patients responding to ≥6/12 pneumococcal polysaccharide vaccine (PPV23) serotypes (primary) and proportions responding to tetanus toxoid vaccine (TTV; secondary) at week 8.


RESULTS
91 patients were randomised. At week 8, 60.0% of TCZ+MTX and 70.8% of MTX patients responded to ≥6/12 PPV23 serotypes, with insufficient evidence for any difference in treatments (10.8% (95% CI -33.7 to 12.0)), and 42.0% and 39.1%, respectively, responded to TTV. Two of three TCZ+MTX patients with non-protective baseline TTV antibody titres achieved protective levels by week 8. The safety profile of TCZ was consistent with previous reports.


CONCLUSIONS
Short-term TCZ treatment does not significantly attenuate humoral responses to PPV23 or TTV. To maximise vaccine response, patients should be up to date with immunisations before starting TCZ treatment.


BACKGROUND
NCT01163747.
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Clifton O
CO
Bingham
Advanced Arthritis Care, Scottsdale, Arizona, USA.
Warren
W
Rizzo
Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA.
Alan
A
Kivitz
Genentech, South San Francisco, California, USA.
Azra
A
Hassanali
Roche, Welwyn Garden City, UK.
Ruchi
R
Upmanyu
Genentech, South San Francisco, California, USA.
Micki
M
Klearman
D000293:Adolescent; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000276:immunology / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000276:immunology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D008297:Male; D008727:Methotrexate / Q000276:immunology / Q000627:therapeutic use*; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology*; D013742:Tetanus / Q000517:prevention & control*; D013745:Tetanus Toxoid / Q000276:immunology*; D055815:Young Adult
D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D022242:Pneumococcal Vaccines; D013745:Tetanus Toxoid; C502936:tocilizumab; D008727:Methotrexate
Methotrexate; Rheumatoid Arthritis; Vaccination