TY - JOUR
T1 - Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease
AU - Melmed, Gil Y.
AU - Agarwal, Nik
AU - Frenck, Robert W.
AU - Ippoliti, Andrew F.
AU - Ibanez, Patricio
AU - Papadakis, Konstantinos A.
AU - Simpson, Peter
AU - Barolet-Garcia, Cristina
AU - Ward, Joel
AU - Targan, Stephan R.
AU - Vasiliauskas, Eric A.
PY - 2010/1
Y1 - 2010/1
N2 - OBJECTIVES:The treatment of inflammatory bowel disease (IBD) often includes immunosuppressive medications, which may increase the risk of vaccine-preventable illnesses. We aimed to assess the impact of immunosuppression on immune responses to pneumococcal vaccination in patients with IBD.METHODS:The study design consists of a prospective controlled clinical trial. This study was carried out at a tertiary-care IBD clinic. The subjects for the study belonged to one of the following three groups: adult patients with IBD on combination TNF-blockers and immunomodulators (Group A), those without immunosuppressive therapy (Group B), and age-matched healthy controls (Group C). The treatment consisted of immunization with 23-valent pneumococcal polysaccharide vaccines (PSVs). The main outcome was immune response for five serotypes defined as a twofold or greater increase from pre-vaccination titers and 1 g post-vaccination titer.RESULTS:Sixty-four subjects participated in the study: 20 in Group A, 25 in Group B, and 19 in Group C. Pre-vaccination titers were similar among the three groups. Vaccine responses were lower in Group A than in Group B (P0.01 for four out of five antigens) and Group C (P0.01 for all five antigens). Overall vaccine response was seen in 45, 80, and 85% of Groups A, B, and C (P0.01), respectively.CONCLUSIONS:Immune response to PSV-23 is impaired in Crohn's disease (CD) patients on combination immunosuppressive therapy but is normal among non-immunosuppressed patients. Given the unpredictable likelihood for immunosuppressive therapy, newly diagnosed patients with IBD should undergo vaccination before the initiation of immunosuppressive therapy.
AB - OBJECTIVES:The treatment of inflammatory bowel disease (IBD) often includes immunosuppressive medications, which may increase the risk of vaccine-preventable illnesses. We aimed to assess the impact of immunosuppression on immune responses to pneumococcal vaccination in patients with IBD.METHODS:The study design consists of a prospective controlled clinical trial. This study was carried out at a tertiary-care IBD clinic. The subjects for the study belonged to one of the following three groups: adult patients with IBD on combination TNF-blockers and immunomodulators (Group A), those without immunosuppressive therapy (Group B), and age-matched healthy controls (Group C). The treatment consisted of immunization with 23-valent pneumococcal polysaccharide vaccines (PSVs). The main outcome was immune response for five serotypes defined as a twofold or greater increase from pre-vaccination titers and 1 g post-vaccination titer.RESULTS:Sixty-four subjects participated in the study: 20 in Group A, 25 in Group B, and 19 in Group C. Pre-vaccination titers were similar among the three groups. Vaccine responses were lower in Group A than in Group B (P0.01 for four out of five antigens) and Group C (P0.01 for all five antigens). Overall vaccine response was seen in 45, 80, and 85% of Groups A, B, and C (P0.01), respectively.CONCLUSIONS:Immune response to PSV-23 is impaired in Crohn's disease (CD) patients on combination immunosuppressive therapy but is normal among non-immunosuppressed patients. Given the unpredictable likelihood for immunosuppressive therapy, newly diagnosed patients with IBD should undergo vaccination before the initiation of immunosuppressive therapy.
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U2 - 10.1038/ajg.2009.523
DO - 10.1038/ajg.2009.523
M3 - Article
C2 - 19755964
AN - SCOPUS:73849132864
SN - 0002-9270
VL - 105
SP - 148
EP - 154
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 1
ER -