Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis
Background Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefin...
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| Veröffentlicht in: | Digestive diseases and sciences 2015-08, Vol.60 (8), p.2446-2453 |
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| creator | Nguyen, Douglas L. Nguyen, Emily T. Bechtold, Matthew L. |
| description | Background
Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations.
Methods
A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel–Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response.
Results
In the pooled analysis of nine studies (
N
= 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55,
p
|
| doi_str_mv | 10.1007/s10620-015-3631-y |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1709191415</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A712943801</galeid><sourcerecordid>A712943801</sourcerecordid><originalsourceid>FETCH-LOGICAL-c542t-9a95b46e9458065af5d338e54a7c3dd765e1fdf9f7592ed7f17796964227aa793</originalsourceid><addsrcrecordid>eNqFktFqFTEQhhdR7LH6AN5IwBtvtmY2m-TEu2OtWqgIpXob0t1Jm7KbrElW2Vfwqc1hq1RRJIQMM98_5Ie_qp4CPQJK5csEVDS0psBrJhjUy71qA1yyuuFie7_aUBClBhAH1aOUbiilSoJ4WB00XCpR7qb6fmItdpkES07HcfYhzdMUMSX3FcnFNUYzOUzEhkjydelENHlEvwq8Hcw4mhziQl6HbziQNy6hSUiCJ-eYpuBLnQM5D3N2Hsln03XOm-zK4BXZkQ-YTb3zZliSS4-rB9YMCZ_cvofVp7cnF8fv67OP706Pd2d1x9sm18ooftkKVC3fUsGN5T1jW-StkR3reyk4gu2tspKrBntpQRazSrRNI42Rih1WL9a9UwxfZkxZjy51OAzGY5iTBkkVKGiB_x8ViksuoN2jz_9Ab8Ici7WVYhwYvUNdmQG18zbkaLr9Ur2T0KiWbSkU6ugvVDk9jq4LHq0r_d8EsAq6GFKKaPUU3WjiooHqfVT0GhVdoqL3UdFL0Ty7_fB8OWL_S_EzGwVoViCVkb_CeMfRP7f-ABTWyF8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1695351305</pqid></control><display><type>article</type><title>Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Nguyen, Douglas L. ; Nguyen, Emily T. ; Bechtold, Matthew L.</creator><creatorcontrib>Nguyen, Douglas L. ; Nguyen, Emily T. ; Bechtold, Matthew L.</creatorcontrib><description>Background
Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations.
Methods
A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel–Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response.
Results
In the pooled analysis of nine studies (
N
= 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55,
p
< 0.001). Specifically, we also demonstrated that patients on immunomodulator monotherapy had a twofold higher probability of achieving adequate immune response to vaccination, compared to patients on anti-tumor necrosis factor (anti-TNF) monotherapy (OR 1.92 95 % CI 1.30, 2.84).
Conclusion
In conclusion, IBD patients on immunosuppressive therapy have a significantly lower response to routine vaccinations. The greatest effect is seen among patients on anti-TNF and combination immunosuppressive therapy. Routine monitoring of vaccine titers post-vaccination is important to ensure that adequate immunologic response has been achieved among IBD patients.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-015-3631-y</identifier><identifier>PMID: 25796579</identifier><identifier>CODEN: DDSCDJ</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Analysis ; Biochemistry ; Biological Factors - pharmacology ; Biological Factors - therapeutic use ; Gastroenterology ; Hepatology ; Humans ; Immune response ; Immunity - drug effects ; Immunomodulation - drug effects ; Immunosuppressive Agents - pharmacology ; Immunosuppressive Agents - therapeutic use ; Inflammatory Bowel Diseases - drug therapy ; Inflammatory Bowel Diseases - immunology ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Oncology ; Original Article ; Transplant Surgery ; Vaccination</subject><ispartof>Digestive diseases and sciences, 2015-08, Vol.60 (8), p.2446-2453</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>COPYRIGHT 2015 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c542t-9a95b46e9458065af5d338e54a7c3dd765e1fdf9f7592ed7f17796964227aa793</citedby><cites>FETCH-LOGICAL-c542t-9a95b46e9458065af5d338e54a7c3dd765e1fdf9f7592ed7f17796964227aa793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-015-3631-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-015-3631-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25796579$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyen, Douglas L.</creatorcontrib><creatorcontrib>Nguyen, Emily T.</creatorcontrib><creatorcontrib>Bechtold, Matthew L.</creatorcontrib><title>Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background
Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations.
Methods
A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel–Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response.
Results
In the pooled analysis of nine studies (
N
= 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55,
p
< 0.001). Specifically, we also demonstrated that patients on immunomodulator monotherapy had a twofold higher probability of achieving adequate immune response to vaccination, compared to patients on anti-tumor necrosis factor (anti-TNF) monotherapy (OR 1.92 95 % CI 1.30, 2.84).
Conclusion
In conclusion, IBD patients on immunosuppressive therapy have a significantly lower response to routine vaccinations. The greatest effect is seen among patients on anti-TNF and combination immunosuppressive therapy. Routine monitoring of vaccine titers post-vaccination is important to ensure that adequate immunologic response has been achieved among IBD patients.</description><subject>Analysis</subject><subject>Biochemistry</subject><subject>Biological Factors - pharmacology</subject><subject>Biological Factors - therapeutic use</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Immune response</subject><subject>Immunity - drug effects</subject><subject>Immunomodulation - drug effects</subject><subject>Immunosuppressive Agents - pharmacology</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Inflammatory Bowel Diseases - drug therapy</subject><subject>Inflammatory Bowel Diseases - immunology</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Transplant Surgery</subject><subject>Vaccination</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFktFqFTEQhhdR7LH6AN5IwBtvtmY2m-TEu2OtWqgIpXob0t1Jm7KbrElW2Vfwqc1hq1RRJIQMM98_5Ie_qp4CPQJK5csEVDS0psBrJhjUy71qA1yyuuFie7_aUBClBhAH1aOUbiilSoJ4WB00XCpR7qb6fmItdpkES07HcfYhzdMUMSX3FcnFNUYzOUzEhkjydelENHlEvwq8Hcw4mhziQl6HbziQNy6hSUiCJ-eYpuBLnQM5D3N2Hsln03XOm-zK4BXZkQ-YTb3zZliSS4-rB9YMCZ_cvofVp7cnF8fv67OP706Pd2d1x9sm18ooftkKVC3fUsGN5T1jW-StkR3reyk4gu2tspKrBntpQRazSrRNI42Rih1WL9a9UwxfZkxZjy51OAzGY5iTBkkVKGiB_x8ViksuoN2jz_9Ab8Ici7WVYhwYvUNdmQG18zbkaLr9Ur2T0KiWbSkU6ugvVDk9jq4LHq0r_d8EsAq6GFKKaPUU3WjiooHqfVT0GhVdoqL3UdFL0Ty7_fB8OWL_S_EzGwVoViCVkb_CeMfRP7f-ABTWyF8</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Nguyen, Douglas L.</creator><creator>Nguyen, Emily T.</creator><creator>Bechtold, Matthew L.</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>20150801</creationdate><title>Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis</title><author>Nguyen, Douglas L. ; Nguyen, Emily T. ; Bechtold, Matthew L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c542t-9a95b46e9458065af5d338e54a7c3dd765e1fdf9f7592ed7f17796964227aa793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Analysis</topic><topic>Biochemistry</topic><topic>Biological Factors - pharmacology</topic><topic>Biological Factors - therapeutic use</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Immune response</topic><topic>Immunity - drug effects</topic><topic>Immunomodulation - drug effects</topic><topic>Immunosuppressive Agents - pharmacology</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Inflammatory Bowel Diseases - drug therapy</topic><topic>Inflammatory Bowel Diseases - immunology</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Transplant Surgery</topic><topic>Vaccination</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyen, Douglas L.</creatorcontrib><creatorcontrib>Nguyen, Emily T.</creatorcontrib><creatorcontrib>Bechtold, Matthew L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyen, Douglas L.</au><au>Nguyen, Emily T.</au><au>Bechtold, Matthew L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>60</volume><issue>8</issue><spage>2446</spage><epage>2453</epage><pages>2446-2453</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><coden>DDSCDJ</coden><abstract>Background
Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations.
Methods
A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel–Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response.
Results
In the pooled analysis of nine studies (
N
= 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55,
p
< 0.001). Specifically, we also demonstrated that patients on immunomodulator monotherapy had a twofold higher probability of achieving adequate immune response to vaccination, compared to patients on anti-tumor necrosis factor (anti-TNF) monotherapy (OR 1.92 95 % CI 1.30, 2.84).
Conclusion
In conclusion, IBD patients on immunosuppressive therapy have a significantly lower response to routine vaccinations. The greatest effect is seen among patients on anti-TNF and combination immunosuppressive therapy. Routine monitoring of vaccine titers post-vaccination is important to ensure that adequate immunologic response has been achieved among IBD patients.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>25796579</pmid><doi>10.1007/s10620-015-3631-y</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2015-08, Vol.60 (8), p.2446-2453 |
| issn | 0163-2116 1573-2568 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Analysis Biochemistry Biological Factors - pharmacology Biological Factors - therapeutic use Gastroenterology Hepatology Humans Immune response Immunity - drug effects Immunomodulation - drug effects Immunosuppressive Agents - pharmacology Immunosuppressive Agents - therapeutic use Inflammatory Bowel Diseases - drug therapy Inflammatory Bowel Diseases - immunology Medical research Medicine Medicine & Public Health Medicine, Experimental Oncology Original Article Transplant Surgery Vaccination |
| title | Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis |
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