title: Immunogenicity of pneumococcal polysaccharide vaccine in adult systemic lupus erythematosus patients undergoing immunosuppressive treatment.
abstract: OBJECTIVE
  To evaluate the immunogenicity of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adult systemic lupus erythematosus patients undergoing (IS group) and not undergoing (non-IS group) immunosuppressive treatment.
  
  
  METHODS
  In this prospective open-label study from February 2013 to April 2014, 54 patients had blood samples collected immediately before PPSV23 immunization and 4-6 weeks thereafter for the ELISA measurement of IgG antibody levels against seven pneumococcal serotypes. Positive vaccine response for each serotype was defined as a four-fold or greater antibody response over baseline levels or as a post-vaccine anti-pneumococcal IgG level ≥1.3 µg/ml when baseline values were <1.3 µg/ml. Patients should have responded appropriately to ≥70% of the tested serotypes. We also calculated the mean ratio of post- to pre-vaccination anti-pneumococcal IgG levels.
  
  
  RESULTS
  Twenty-eight patients were classified into the IS group and 26 into non-IS group. The median dose of prednisone at baseline was ≤5 mg/day in both groups. Serotype-specific vaccine response rates were not significantly different between the groups. Less than 40% of patients responded adequately by both vaccine response criteria, being numerically lower among IS patients. The mean ratio of increase in anti-pneumococcal levels was 6.4 versus 4.7 (p = 0.001) in non-IS and IS groups, respectively.
  
  
  CONCLUSIONS
  The vaccine was poorly immunogenic, especially among adult systemic lupus erythematosus patients under immunosuppressive therapy.
authors.affiliation: Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil ropoubel@yahoo.com.br.
authors.forename: R P V
authors.initials: RP
authors.lastname: Rezende
authors.affiliation: Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: F M
authors.initials: FM
authors.lastname: Ribeiro
authors.affiliation: Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: E M N
authors.initials: EM
authors.lastname: Albuquerque
authors.affiliation: Department of Biochemistry, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: C R
authors.initials: CR
authors.lastname: Gayer
authors.affiliation: Fleury Medicina Diagnóstica, São Paulo, Brazil.
authors.forename: L E C
authors.initials: LE
authors.lastname: Andrade
authors.affiliation: Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: E M
authors.initials: EM
authors.lastname: Klumb
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D000071497:Immunogenicity, Vaccine; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011446:Prospective Studies; D065288:Serogroup
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D007166:Immunosuppressive Agents; D022242:Pneumococcal Vaccines
keywords: Systemic lupus erythematosus; immunogenicity; immunosuppression; immunosuppressive drugs; pneumococcal polysaccharide vaccine; treatment