Immunosuppressive drugs impairs antibody response of the polysaccharide and conjugated pneumococcal vaccines in patients with Crohn's disease.
BACKGROUND
Patients with Crohn's disease (CD) have a higher risk of infectious diseases including pneumococcal infections, and the risk increases with immunotherapy. The primary endpoint of this study was to investigate the specific antibody response to two pneumococcal vaccines in CD patients with and without immunosuppressive treatment four weeks post vaccination.


METHODS
In a randomized trial of the 23-valent pneumococcal polysaccharide vaccine (PPV23) and the 13-valent pneumococcal conjugated vaccine (PCV13), a group of CD patients treated with immunosuppressive drugs (IS) alone or in combination with TNF-α antagonists were compared to a group of CD patients not treated with any of these drugs (untreated). Specific pneumococcal antibody concentrations were measured against 12 serotypes common to the two vaccines before and 4 week after vaccination.


RESULTS
PCV13 induced a significantly higher antibody response for one serotype (23F) in IS treated patients and for two serotypes (9V and 23F) in untreated patients compared to CD patients vaccinated with PPV23. Untreated PPV23 recipients had higher responses for serotypes 9V and 18C compared to IS+TNF-α treated PPV23 recipients. Comparison between treatment groups showed that immunosuppressive treatment impaired the antibody response to both vaccines and that TNF-a treatment further conveyed additional impairment of the response.


CONCLUSIONS
PCV13 induces higher antibody response for some serotypes compared to PPV23. In addition, CD patients treated with immunosuppressive drugs alone or in combination with TNF-α antagonists had an impaired antibody response to both PPV23 and PCV13 compared to patients not receiving any of these treatments. The study has been registered in the European Clinical Trials Database (EudraCT, record no 2012-002867-86) and ClinicalTrials.gov (record no. NCT01947010).
Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark. Electronic address: bjk@ssi.dk.
Bjørn
B
Kantsø
Department of Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
Sofie Ingdam
SI
Halkjær
Department of Gastroenterology, Herlev University Hospital, Herlev, Denmark.
Ole Østergaard
OØ
Thomsen
Department of Gastroenterology, Herlev University Hospital, Herlev, Denmark.
Erika
E
Belard
Department of Gastroenterology, Herlev University Hospital, Herlev, Denmark.
Ida Benedikte
IB
Gottschalck
Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark.
Charlotte Sværke
CS
Jørgensen
Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
Karen A
KA
Krogfelt
Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
Hans-Christian
HC
Slotved
Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
Helene
H
Ingels
Department of Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark; Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.
Andreas Munk
AM
Petersen
D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D000917:Antibody Formation / Q000187:drug effects* / Q000276:immunology*; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D011135:Polysaccharides, Bacterial / Q000276:immunology*; D013296:Streptococcus pneumoniae / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use; D014611:Vaccination; D018074:Vaccines, Conjugate
C538862:13-valent pneumococcal vaccine; C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000907:Antibodies, Bacterial; D007166:Immunosuppressive Agents; D022242:Pneumococcal Vaccines; D011135:Polysaccharides, Bacterial; D014409:Tumor Necrosis Factor-alpha; D018074:Vaccines, Conjugate
13-Valent conjugated pneumococcal vaccine; 23-Valent pneumococcal polysaccharide vaccine; Crohn's disease; Inflammatory bowel disease; Pneumococcus; Vaccination