title: Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis.
abstract: BACKGROUND
  Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations.
  
  
  METHODS
  A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response.
  
  
  RESULTS
  In the pooled analysis of nine studies (N = 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55, p < 0.001). Specifically, we also demonstrated that patients on immunomodulator monotherapy had a twofold higher probability of achieving adequate immune response to vaccination, compared to patients on anti-tumor necrosis factor (anti-TNF) monotherapy (OR 1.92 95 % CI 1.30, 2.84).
  
  
  CONCLUSIONS
  In conclusion, IBD patients on immunosuppressive therapy have a significantly lower response to routine vaccinations. The greatest effect is seen among patients on anti-TNF and combination immunosuppressive therapy. Routine monitoring of vaccine titers post-vaccination is important to ensure that adequate immunologic response has been achieved among IBD patients.
authors: Department of Medicine, UC Irvine School of Medicine, University of California - Irvine, 333 City Blvd. West, Suite 400, Orange, CA, 92868, USA, douglaln@uci.edu.
authors: Douglas L
authors: DL
authors: Nguyen
authors: Emily T
authors: ET
authors: Nguyen
authors: Matthew L
authors: ML
authors: Bechtold
mesh_terms: D001685:Biological Factors / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D007109:Immunity / Q000187:drug effects*; D056747:Immunomodulation / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology*; D014611:Vaccination
chemical_list: D001685:Biological Factors; D007166:Immunosuppressive Agents