title: Longterm Efficacy of an Antipneumococcal Polysaccharide Vaccine among Patients with Autoimmune Inflammatory Rheumatic Diseases.
abstract: OBJECTIVE
  To estimate the longterm humoral response of an antipneumococcal polysaccharide vaccine (PPSV23) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), or inflammatory bowel disease (IBD)-associated spondyloarthropathy (SpA), and the effect of demographic and clinical factors and treatment on the longterm efficacy of the vaccine.
  
  
  METHODS
  A total of 145 consecutive patients treated with biologics [tumor necrosis factor-α (TNF-α) or interleukin 6 (IL-6) receptor inhibitors] or methotrexate (MTX) participated in this study. Fifteen were excluded because of absent information regarding their vaccination status (n = 9) or because of technical problems in obtaining their serum sample (n = 6). They were diagnosed with RA (n = 63, 48.5%), PsA (n = 29, 22.3%), AS (n = 28, 21.5%), or IBD-associated SpA (n = 3, 2.3%). Their mean age was 54.6 years, and 61.5% were women. Data were collected on the timing of vaccination, demographic and clinical characteristics, and treatment, and patients' serum antipneumococcal antibody levels were tested.
  
  
  RESULTS
  Two-thirds of the patients (67.7%) had received PPSV23 45 months (mean) earlier. Treatment included TNF-α inhibitors (73.9%), IL-6 receptor inhibitors (13.1%), or MTX without a biological treatment (13%). The uptake of vaccination was significantly higher in the older population (> 65 yrs). Vaccinated patients had significantly higher antibody levels compared with vaccine-naive patients. The antibody levels had been preserved after 10 years. MTX use, but not biologics, was associated with significantly lower antibody levels.
  
  
  CONCLUSIONS
  The longterm efficacy of the PPSV23 vaccination seems to be preserved among patients with RA, PsA, AS, and IBD-associated SpA for at least 10 years. Efficacy is slightly impaired by MTX, but it is not affected by biologics. These findings suggest that revaccination after 5 years might not be needed for all, and testing the antibody titers should be considered to identify those who may benefit from revaccination.
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Adi
authors.initials: A
authors.lastname: Broyde
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Uri
authors.initials: U
authors.lastname: Arad
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Noa
authors.initials: N
authors.lastname: Madar-Balakirski
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Daphna
authors.initials: D
authors.lastname: Paran
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Ilana
authors.initials: I
authors.lastname: Kaufman
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: David
authors.initials: D
authors.lastname: Levartovsky
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Irena
authors.initials: I
authors.lastname: Wigler
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University.
authors.forename: Dan
authors.initials: D
authors.lastname: Caspi
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.A. Broyde, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; U. Arad, MD, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; N. Madar-Balakirski, PhD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Paran, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Kaufman, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; I. Wigler, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; D. Caspi, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University; O. Elkayam, M.D, Department of Rheumatology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University. oribe14@netvision.net.il.
authors.forename: Ori
authors.initials: O
authors.lastname: Elkayam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000150:complications / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D014611:Vaccination; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D022242:Pneumococcal Vaccines
keywords: AUTOIMMUNE; EFFICACY; PNEUMOCOCCAL; RHEUMATOID ARTHRITIS; VACCINE