Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases—a prospective multi-centre cohort study
Abstract Objectives We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs). Methods We conducted a mult...
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| Veröffentlicht in: | Rheumatology (Oxford, England) England), 2019-09, Vol.58 (9), p.1585-1596 |
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| creator | Bühler, Silja Jaeger, Veronika Katharina Adler, Sabine Bannert, Bettina Brümmerhoff, Carolin Ciurea, Adrian Distler, Oliver Franz, Juliane Gabay, Cem Hagenbuch, Niels Herzog, Christian Hasler, Paul Kling, Kerstin Kyburz, Diego Müller, Rüdiger Nissen, Michael John Siegrist, Claire-Anne Villiger, Peter Matthias Walker, Ulrich A. Hatz, Christoph |
| description | Abstract
Objectives
We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs).
Methods
We conducted a multi-centre prospective cohort study in Switzerland. We enrolled patients with RA, axial SpA/PsA, vasculitis (Behçet’s disease, ANCA-associated vasculitis) and HCs. Diphtheria/tetanus vaccination was administered according to the Swiss vaccination recommendations. Blood samples were drawn before vaccination, and 1 month and 3 months afterwards. Antibody concentrations against vaccine antigens were measured by ELISA. Immunogenicity was compared between patient and medication groups. A mixed model was applied for multivariate analysis. Missing data were dealt with using multiple imputation.
Results
Between January 2014 and December 2015, we enrolled 284 patients with rheumatic diseases (131 RA, 114 SpA/PsA, 39 vasculitis) and 253 HCs. Of the patients, 89% were on immunosuppressive/immunomodulatory medication. Three months post-vaccination 100% of HCs vs 98% of patients were protected against tetanus and 84% vs 73% against diphtheria. HCs and SpA/PsA patients had significantly higher responses than RA and vasculitis patients. Assessing underlying diseases and medications in a multivariate model, rituximab was the only factor negatively influencing tetanus immunogenicity, whereas only MTX treatment had a negative influence on diphtheria antibody responses. No vaccine-related serious adverse events were recorded.
Conclusion
Diphtheria/tetanus booster vaccination was safe. Tetanus vaccination was immunogenic; the diphtheria component was less immunogenic. Vaccine responses were blunted by rituximab and MTX.
Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, Identifier: NCT01947465. |
| doi_str_mv | 10.1093/rheumatology/kez045 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2193169415</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/rheumatology/kez045</oup_id><sourcerecordid>2474941451</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-1023119c0fbd7a67a55ddbc193820cc548e2306db49ceb27d9e6e0979d2f47f43</originalsourceid><addsrcrecordid>eNqNkUtP3DAUha2qqNBpf0ElZIkNmzB-JZksK8SjEhIL2nXk2DfEkNipH6BhxZY9v5BfUlczRYhVvfGV9Z2jc30Q-kbJESUNX_oB0iSjG931enkLD0SUH9AeFRUrCOfs4-vMxC76HMINIaSkfPUJ7XKyqvPhe-jpSvYQ11hajc00JeuuwRpl8pPrcYQobQpLbeYhDuCNxHdSKWNlNM5iY_GcJ7Ax4HsTB7yNZBTWJoAMEF4enyWevQszqGjuAE9pjKZQWeMBKzc4H3GISa-_oJ1ejgG-bu8F-nV68vP4vLi4PPtx_P2iULxmsaCEcUobRfpO17KqZVlq3Sna8BUjSpViBYyTSneiUdCxWjdQAWnqRrNe1L3gC3S48c2pficIsZ1MUDCO0oJLoWXZilaNoGVGD96hNy55m9O1TNQiMyJ_6ALxDaXymsFD387eTNKvW0rav021b5tqN01l1f7WO3UT6FfNv2oycLQBXJr_y_EPsV-pJw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2474941451</pqid></control><display><type>article</type><title>Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases—a prospective multi-centre cohort study</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Bühler, Silja ; Jaeger, Veronika Katharina ; Adler, Sabine ; Bannert, Bettina ; Brümmerhoff, Carolin ; Ciurea, Adrian ; Distler, Oliver ; Franz, Juliane ; Gabay, Cem ; Hagenbuch, Niels ; Herzog, Christian ; Hasler, Paul ; Kling, Kerstin ; Kyburz, Diego ; Müller, Rüdiger ; Nissen, Michael John ; Siegrist, Claire-Anne ; Villiger, Peter Matthias ; Walker, Ulrich A. ; Hatz, Christoph</creator><creatorcontrib>Bühler, Silja ; Jaeger, Veronika Katharina ; Adler, Sabine ; Bannert, Bettina ; Brümmerhoff, Carolin ; Ciurea, Adrian ; Distler, Oliver ; Franz, Juliane ; Gabay, Cem ; Hagenbuch, Niels ; Herzog, Christian ; Hasler, Paul ; Kling, Kerstin ; Kyburz, Diego ; Müller, Rüdiger ; Nissen, Michael John ; Siegrist, Claire-Anne ; Villiger, Peter Matthias ; Walker, Ulrich A. ; Hatz, Christoph</creatorcontrib><description>Abstract
Objectives
We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs).
Methods
We conducted a multi-centre prospective cohort study in Switzerland. We enrolled patients with RA, axial SpA/PsA, vasculitis (Behçet’s disease, ANCA-associated vasculitis) and HCs. Diphtheria/tetanus vaccination was administered according to the Swiss vaccination recommendations. Blood samples were drawn before vaccination, and 1 month and 3 months afterwards. Antibody concentrations against vaccine antigens were measured by ELISA. Immunogenicity was compared between patient and medication groups. A mixed model was applied for multivariate analysis. Missing data were dealt with using multiple imputation.
Results
Between January 2014 and December 2015, we enrolled 284 patients with rheumatic diseases (131 RA, 114 SpA/PsA, 39 vasculitis) and 253 HCs. Of the patients, 89% were on immunosuppressive/immunomodulatory medication. Three months post-vaccination 100% of HCs vs 98% of patients were protected against tetanus and 84% vs 73% against diphtheria. HCs and SpA/PsA patients had significantly higher responses than RA and vasculitis patients. Assessing underlying diseases and medications in a multivariate model, rituximab was the only factor negatively influencing tetanus immunogenicity, whereas only MTX treatment had a negative influence on diphtheria antibody responses. No vaccine-related serious adverse events were recorded.
Conclusion
Diphtheria/tetanus booster vaccination was safe. Tetanus vaccination was immunogenic; the diphtheria component was less immunogenic. Vaccine responses were blunted by rituximab and MTX.
Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, Identifier: NCT01947465.</description><identifier>ISSN: 1462-0324</identifier><identifier>EISSN: 1462-0332</identifier><identifier>DOI: 10.1093/rheumatology/kez045</identifier><identifier>PMID: 30877773</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adult ; Adverse events ; Aged ; Aged, 80 and over ; Antibodies, Bacterial - biosynthesis ; Antigens ; Antineutrophil cytoplasmic antibodies ; Clostridium tetani - immunology ; Cohort analysis ; Corynebacterium diphtheriae - immunology ; Diphtheria ; Diphtheria - prevention & control ; Diphtheria-Tetanus Vaccine - adverse effects ; Diphtheria-Tetanus Vaccine - immunology ; Enzyme-linked immunosorbent assay ; Female ; Humans ; Immunization ; Immunization, Secondary ; Immunogenicity ; Immunogenicity, Vaccine - drug effects ; Immunogenicity, Vaccine - immunology ; Immunomodulation ; Immunosuppressive Agents - pharmacology ; Immunosuppressive Agents - therapeutic use ; Male ; Middle Aged ; Monoclonal antibodies ; Multivariate analysis ; Patients ; Prospective Studies ; Rheumatic diseases ; Rheumatic Diseases - drug therapy ; Rheumatic Diseases - immunology ; Rituximab ; Tetanus ; Tetanus - prevention & control ; Vaccination ; Vaccines ; Vasculitis ; Young Adult</subject><ispartof>Rheumatology (Oxford, England), 2019-09, Vol.58 (9), p.1585-1596</ispartof><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-1023119c0fbd7a67a55ddbc193820cc548e2306db49ceb27d9e6e0979d2f47f43</citedby><cites>FETCH-LOGICAL-c372t-1023119c0fbd7a67a55ddbc193820cc548e2306db49ceb27d9e6e0979d2f47f43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1583,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30877773$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bühler, Silja</creatorcontrib><creatorcontrib>Jaeger, Veronika Katharina</creatorcontrib><creatorcontrib>Adler, Sabine</creatorcontrib><creatorcontrib>Bannert, Bettina</creatorcontrib><creatorcontrib>Brümmerhoff, Carolin</creatorcontrib><creatorcontrib>Ciurea, Adrian</creatorcontrib><creatorcontrib>Distler, Oliver</creatorcontrib><creatorcontrib>Franz, Juliane</creatorcontrib><creatorcontrib>Gabay, Cem</creatorcontrib><creatorcontrib>Hagenbuch, Niels</creatorcontrib><creatorcontrib>Herzog, Christian</creatorcontrib><creatorcontrib>Hasler, Paul</creatorcontrib><creatorcontrib>Kling, Kerstin</creatorcontrib><creatorcontrib>Kyburz, Diego</creatorcontrib><creatorcontrib>Müller, Rüdiger</creatorcontrib><creatorcontrib>Nissen, Michael John</creatorcontrib><creatorcontrib>Siegrist, Claire-Anne</creatorcontrib><creatorcontrib>Villiger, Peter Matthias</creatorcontrib><creatorcontrib>Walker, Ulrich A.</creatorcontrib><creatorcontrib>Hatz, Christoph</creatorcontrib><title>Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases—a prospective multi-centre cohort study</title><title>Rheumatology (Oxford, England)</title><addtitle>Rheumatology (Oxford)</addtitle><description>Abstract
Objectives
We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs).
Methods
We conducted a multi-centre prospective cohort study in Switzerland. We enrolled patients with RA, axial SpA/PsA, vasculitis (Behçet’s disease, ANCA-associated vasculitis) and HCs. Diphtheria/tetanus vaccination was administered according to the Swiss vaccination recommendations. Blood samples were drawn before vaccination, and 1 month and 3 months afterwards. Antibody concentrations against vaccine antigens were measured by ELISA. Immunogenicity was compared between patient and medication groups. A mixed model was applied for multivariate analysis. Missing data were dealt with using multiple imputation.
Results
Between January 2014 and December 2015, we enrolled 284 patients with rheumatic diseases (131 RA, 114 SpA/PsA, 39 vasculitis) and 253 HCs. Of the patients, 89% were on immunosuppressive/immunomodulatory medication. Three months post-vaccination 100% of HCs vs 98% of patients were protected against tetanus and 84% vs 73% against diphtheria. HCs and SpA/PsA patients had significantly higher responses than RA and vasculitis patients. Assessing underlying diseases and medications in a multivariate model, rituximab was the only factor negatively influencing tetanus immunogenicity, whereas only MTX treatment had a negative influence on diphtheria antibody responses. No vaccine-related serious adverse events were recorded.
Conclusion
Diphtheria/tetanus booster vaccination was safe. Tetanus vaccination was immunogenic; the diphtheria component was less immunogenic. Vaccine responses were blunted by rituximab and MTX.
Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, Identifier: NCT01947465.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adverse events</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibodies, Bacterial - biosynthesis</subject><subject>Antigens</subject><subject>Antineutrophil cytoplasmic antibodies</subject><subject>Clostridium tetani - immunology</subject><subject>Cohort analysis</subject><subject>Corynebacterium diphtheriae - immunology</subject><subject>Diphtheria</subject><subject>Diphtheria - prevention & control</subject><subject>Diphtheria-Tetanus Vaccine - adverse effects</subject><subject>Diphtheria-Tetanus Vaccine - immunology</subject><subject>Enzyme-linked immunosorbent assay</subject><subject>Female</subject><subject>Humans</subject><subject>Immunization</subject><subject>Immunization, Secondary</subject><subject>Immunogenicity</subject><subject>Immunogenicity, Vaccine - drug effects</subject><subject>Immunogenicity, Vaccine - immunology</subject><subject>Immunomodulation</subject><subject>Immunosuppressive Agents - pharmacology</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Rheumatic diseases</subject><subject>Rheumatic Diseases - drug therapy</subject><subject>Rheumatic Diseases - immunology</subject><subject>Rituximab</subject><subject>Tetanus</subject><subject>Tetanus - prevention & control</subject><subject>Vaccination</subject><subject>Vaccines</subject><subject>Vasculitis</subject><subject>Young Adult</subject><issn>1462-0324</issn><issn>1462-0332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUtP3DAUha2qqNBpf0ElZIkNmzB-JZksK8SjEhIL2nXk2DfEkNipH6BhxZY9v5BfUlczRYhVvfGV9Z2jc30Q-kbJESUNX_oB0iSjG931enkLD0SUH9AeFRUrCOfs4-vMxC76HMINIaSkfPUJ7XKyqvPhe-jpSvYQ11hajc00JeuuwRpl8pPrcYQobQpLbeYhDuCNxHdSKWNlNM5iY_GcJ7Ax4HsTB7yNZBTWJoAMEF4enyWevQszqGjuAE9pjKZQWeMBKzc4H3GISa-_oJ1ejgG-bu8F-nV68vP4vLi4PPtx_P2iULxmsaCEcUobRfpO17KqZVlq3Sna8BUjSpViBYyTSneiUdCxWjdQAWnqRrNe1L3gC3S48c2pficIsZ1MUDCO0oJLoWXZilaNoGVGD96hNy55m9O1TNQiMyJ_6ALxDaXymsFD387eTNKvW0rav021b5tqN01l1f7WO3UT6FfNv2oycLQBXJr_y_EPsV-pJw</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Bühler, Silja</creator><creator>Jaeger, Veronika Katharina</creator><creator>Adler, Sabine</creator><creator>Bannert, Bettina</creator><creator>Brümmerhoff, Carolin</creator><creator>Ciurea, Adrian</creator><creator>Distler, Oliver</creator><creator>Franz, Juliane</creator><creator>Gabay, Cem</creator><creator>Hagenbuch, Niels</creator><creator>Herzog, Christian</creator><creator>Hasler, Paul</creator><creator>Kling, Kerstin</creator><creator>Kyburz, Diego</creator><creator>Müller, Rüdiger</creator><creator>Nissen, Michael John</creator><creator>Siegrist, Claire-Anne</creator><creator>Villiger, Peter Matthias</creator><creator>Walker, Ulrich A.</creator><creator>Hatz, Christoph</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</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>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20190901</creationdate><title>Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases—a prospective multi-centre cohort study</title><author>Bühler, Silja ; Jaeger, Veronika Katharina ; Adler, Sabine ; Bannert, Bettina ; Brümmerhoff, Carolin ; Ciurea, Adrian ; Distler, Oliver ; Franz, Juliane ; Gabay, Cem ; Hagenbuch, Niels ; Herzog, Christian ; Hasler, Paul ; Kling, Kerstin ; Kyburz, Diego ; Müller, Rüdiger ; Nissen, Michael John ; Siegrist, Claire-Anne ; Villiger, Peter Matthias ; Walker, Ulrich A. ; Hatz, Christoph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-1023119c0fbd7a67a55ddbc193820cc548e2306db49ceb27d9e6e0979d2f47f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adverse events</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibodies, Bacterial - biosynthesis</topic><topic>Antigens</topic><topic>Antineutrophil cytoplasmic antibodies</topic><topic>Clostridium tetani - immunology</topic><topic>Cohort analysis</topic><topic>Corynebacterium diphtheriae - immunology</topic><topic>Diphtheria</topic><topic>Diphtheria - prevention & control</topic><topic>Diphtheria-Tetanus Vaccine - adverse effects</topic><topic>Diphtheria-Tetanus Vaccine - immunology</topic><topic>Enzyme-linked immunosorbent assay</topic><topic>Female</topic><topic>Humans</topic><topic>Immunization</topic><topic>Immunization, Secondary</topic><topic>Immunogenicity</topic><topic>Immunogenicity, Vaccine - drug effects</topic><topic>Immunogenicity, Vaccine - immunology</topic><topic>Immunomodulation</topic><topic>Immunosuppressive Agents - pharmacology</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>Multivariate analysis</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Rheumatic diseases</topic><topic>Rheumatic Diseases - drug therapy</topic><topic>Rheumatic Diseases - immunology</topic><topic>Rituximab</topic><topic>Tetanus</topic><topic>Tetanus - prevention & control</topic><topic>Vaccination</topic><topic>Vaccines</topic><topic>Vasculitis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bühler, Silja</creatorcontrib><creatorcontrib>Jaeger, Veronika Katharina</creatorcontrib><creatorcontrib>Adler, Sabine</creatorcontrib><creatorcontrib>Bannert, Bettina</creatorcontrib><creatorcontrib>Brümmerhoff, Carolin</creatorcontrib><creatorcontrib>Ciurea, Adrian</creatorcontrib><creatorcontrib>Distler, Oliver</creatorcontrib><creatorcontrib>Franz, Juliane</creatorcontrib><creatorcontrib>Gabay, Cem</creatorcontrib><creatorcontrib>Hagenbuch, Niels</creatorcontrib><creatorcontrib>Herzog, Christian</creatorcontrib><creatorcontrib>Hasler, Paul</creatorcontrib><creatorcontrib>Kling, Kerstin</creatorcontrib><creatorcontrib>Kyburz, Diego</creatorcontrib><creatorcontrib>Müller, Rüdiger</creatorcontrib><creatorcontrib>Nissen, Michael John</creatorcontrib><creatorcontrib>Siegrist, Claire-Anne</creatorcontrib><creatorcontrib>Villiger, Peter Matthias</creatorcontrib><creatorcontrib>Walker, Ulrich A.</creatorcontrib><creatorcontrib>Hatz, Christoph</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Rheumatology (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bühler, Silja</au><au>Jaeger, Veronika Katharina</au><au>Adler, Sabine</au><au>Bannert, Bettina</au><au>Brümmerhoff, Carolin</au><au>Ciurea, Adrian</au><au>Distler, Oliver</au><au>Franz, Juliane</au><au>Gabay, Cem</au><au>Hagenbuch, Niels</au><au>Herzog, Christian</au><au>Hasler, Paul</au><au>Kling, Kerstin</au><au>Kyburz, Diego</au><au>Müller, Rüdiger</au><au>Nissen, Michael John</au><au>Siegrist, Claire-Anne</au><au>Villiger, Peter Matthias</au><au>Walker, Ulrich A.</au><au>Hatz, Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases—a prospective multi-centre cohort study</atitle><jtitle>Rheumatology (Oxford, England)</jtitle><addtitle>Rheumatology (Oxford)</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>58</volume><issue>9</issue><spage>1585</spage><epage>1596</epage><pages>1585-1596</pages><issn>1462-0324</issn><eissn>1462-0332</eissn><abstract>Abstract
Objectives
We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs).
Methods
We conducted a multi-centre prospective cohort study in Switzerland. We enrolled patients with RA, axial SpA/PsA, vasculitis (Behçet’s disease, ANCA-associated vasculitis) and HCs. Diphtheria/tetanus vaccination was administered according to the Swiss vaccination recommendations. Blood samples were drawn before vaccination, and 1 month and 3 months afterwards. Antibody concentrations against vaccine antigens were measured by ELISA. Immunogenicity was compared between patient and medication groups. A mixed model was applied for multivariate analysis. Missing data were dealt with using multiple imputation.
Results
Between January 2014 and December 2015, we enrolled 284 patients with rheumatic diseases (131 RA, 114 SpA/PsA, 39 vasculitis) and 253 HCs. Of the patients, 89% were on immunosuppressive/immunomodulatory medication. Three months post-vaccination 100% of HCs vs 98% of patients were protected against tetanus and 84% vs 73% against diphtheria. HCs and SpA/PsA patients had significantly higher responses than RA and vasculitis patients. Assessing underlying diseases and medications in a multivariate model, rituximab was the only factor negatively influencing tetanus immunogenicity, whereas only MTX treatment had a negative influence on diphtheria antibody responses. No vaccine-related serious adverse events were recorded.
Conclusion
Diphtheria/tetanus booster vaccination was safe. Tetanus vaccination was immunogenic; the diphtheria component was less immunogenic. Vaccine responses were blunted by rituximab and MTX.
Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, Identifier: NCT01947465.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30877773</pmid><doi>10.1093/rheumatology/kez045</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1462-0324 |
| ispartof | Rheumatology (Oxford, England), 2019-09, Vol.58 (9), p.1585-1596 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Adult Adverse events Aged Aged, 80 and over Antibodies, Bacterial - biosynthesis Antigens Antineutrophil cytoplasmic antibodies Clostridium tetani - immunology Cohort analysis Corynebacterium diphtheriae - immunology Diphtheria Diphtheria - prevention & control Diphtheria-Tetanus Vaccine - adverse effects Diphtheria-Tetanus Vaccine - immunology Enzyme-linked immunosorbent assay Female Humans Immunization Immunization, Secondary Immunogenicity Immunogenicity, Vaccine - drug effects Immunogenicity, Vaccine - immunology Immunomodulation Immunosuppressive Agents - pharmacology Immunosuppressive Agents - therapeutic use Male Middle Aged Monoclonal antibodies Multivariate analysis Patients Prospective Studies Rheumatic diseases Rheumatic Diseases - drug therapy Rheumatic Diseases - immunology Rituximab Tetanus Tetanus - prevention & control Vaccination Vaccines Vasculitis Young Adult |
| title | Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases—a prospective multi-centre cohort study |
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