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Open Access 01-12-2015 | Research article

Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tacrolimus

Authors: Kiyoshi Migita, Yukihiro Akeda, Manabu Akazawa, Shigeto Tohma, Fuminori Hirano, Haruko Ideguchi, Ryutaro Matsumura, Eiichi Suematsu, Tomoya Miyamura, Shunsuke Mori, Takahiro Fukui, Yasumori Izumi, Nozomi Iwanaga, Hiroshi Tsutani, Kouichirou Saisyo, Takao Yamanaka, Shiro Ohshima, Takao Sugiyama, Yojiro Kawabe, Masao Katayama, Yasuo Suenaga, Akira Okamoto, Hisaji Ohshima, Yasumasa Okada, Kenji Ichikawa, Shigeru Yoshizawa, Kenji Kawakami, Toshihiro Matsui, Hiroshi Furukawa, Kazunori Oishi

Published in: Arthritis Research & Therapy | Issue 1/2015

Abstract

Introduction

In rheumatoid arthritis (RA) patients receiving immunosuppressive treatments, vaccination against Streptococcus pneumoniae is recommended. The objective of the study was to evaluate the effects of tacrolimus (TAC) on immune response following administration of a 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients with established RA.

Methods

Patients with RA (n = 133) were vaccinated with PPSV23. Patients were classified into TAC (n = 29), methotrexate (MTX) (n = 55), control (n = 35), and TAC/MTX (n = 14) treatment groups. We measured the concentrations of pneumococcal serotypes 6B and 23F by using an enzyme-linked immunosorbent assay and determined antibody functionality by using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI), before and 4 to 6 weeks after vaccination. A positive antibody response was defined as at least a twofold increase in the IgG concentration or as at least a 10-fold increase in the OI.

Results

IgG concentrations and OIs were significantly increased in all treatment groups after PPSV23 vaccination. The TAC treatment group appears to respond in a manner similar to that of the RA control group in terms of 6B and 23F serotype concentration and function. In contrast, the MTX group had the lowest immune response. Patients who received a combination of TAC and MTX (TAC/MTX) also had a diminished immune response compared with those who received TAC alone.

Conclusions

TAC monotherapy does not appear to impair PPSV23 immunogenicity in patients with RA, whereas antibody production and function may be reduced when TAC is used with MTX. Thus, PPSV23 administration during ongoing TAC treatment should be encouraged for infection-prone TAC-treated patients with rheumatic diseases.

Trial registration

University Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012.

Available only for authorised users

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Title: Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tacrolimus
Authors: Kiyoshi Migita
Yukihiro Akeda
Manabu Akazawa
Shigeto Tohma
Fuminori Hirano
Haruko Ideguchi
Ryutaro Matsumura
Eiichi Suematsu
Tomoya Miyamura
Shunsuke Mori
Takahiro Fukui
Yasumori Izumi
Nozomi Iwanaga
Hiroshi Tsutani
Kouichirou Saisyo
Takao Yamanaka
Shiro Ohshima
Takao Sugiyama
Yojiro Kawabe
Masao Katayama
Yasuo Suenaga
Akira Okamoto
Hisaji Ohshima
Yasumasa Okada
Kenji Ichikawa
Shigeru Yoshizawa
Kenji Kawakami
Toshihiro Matsui
Hiroshi Furukawa
Kazunori Oishi
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Arthritis Research & Therapy / Issue 1/2015
Electronic ISSN: 1478-6362
DOI: https://doi.org/10.1186/s13075-015-0662-x

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Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tacrolimus

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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