Antibody response to pneumococcal and influenza vaccination in patients with rheumatoid arthritis receiving abatacept
Open accessAbstract
BACKGROUND: Patients with rheumatoid arthritis (RA), including those treated with biologics, are at increased risk of some vaccine-preventable infections. We evaluated the antibody response to standard 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 2011-2012 trivalent seasonal influenza vaccine in adults with RA receiving subcutaneous (SC) abatacept and background disease-modifying anti-rheumatic drugs (DMARDs). METHODS: Two multicenter, open-label sub-studies enrolled patients from the ACQUIRE (pneumococcal and influenza) and ATTUNE (pneumococcal) studies at any point during their SC abatacept treatment cycle following completion of ≥3 months' SC abatacept. All patients received fixed-dose abatacept 125 mg/week with background DMARDs. A pre-vaccination blood sample was taken, and after 28 ± 3 days a final post-vaccination sample was collected. The primary endpoint was the proportion of patients achieving an immunologic response to the vaccine at Day 28 among patients without a protective antibody level to the vaccine antigens at baseline (pneumococcal: defined as ≥2-fold increase in post-vaccination titers to ≥3 of 5 antigens and protective antibody level of ≥1.6 μg/mL to ≥3 of 5 antigens; influenza: defined as ≥4-fold increase in post-vaccination titers to ≥2 of 3 antigens and protective antibody level of ≥1:40 to ≥2 of 3 antigens). Safety and tolerability were evaluated throughout the sub-studies. RESULTS: Pre- and post-vaccination titers were available for 113/125 and 186/191 enrolled patients receiving the PPSV23 and influenza vaccine, respectively. Among vaccinated patients, 47/113 pneumococcal and 121/186 influenza patients were without protective antibody levels at baseline. Among patients with available data, 73.9 % (34/46) and 61.3 % (73/119) met the primary endpoint and achieved an immunologic response to PPSV23 or influenza vaccine, respectively. In patients with pre- and post-vaccination data available, 83.9 % in the pneumococcal study demonstrated protective antibody levels with PPSV23 (titer ≥1.6 μg/mL to ≥3 of 5 antigens), and 81.2 % in the influenza study achieved protective antibody levels (titer ≥1:40 to ≥2 of 3 antigens) at Day 28 post-vaccination. Vaccines were well tolerated with SC abatacept with background DMARDs. CONCLUSIONS: In these sub-studies, patients with RA receiving SC abatacept and background DMARDs were able to mount an appropriate immune response to pneumococcal and influenza vaccines. TRIAL REGISTRATION: NCT00559585 (registered 15 November 2007) and NCT00663702 (registered 18 April 2008).
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Prior findings on how abatacept affects other vaccination-related immunity are inconsistent.
“Previous data regarding the impact of abatacept on other vaccination-related immunity are conflicting.29 42”
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Self-citation
- Authors
- Alten, R., Bingham, C. O., Cohen, S. B., Curtis, J. R., Kelly, S., Wong, D., & Genovese, M. C.
- Affiliations
- Schlosspark-Klinik (DE)
- Johns Hopkins University (US)
- Metroplex Clinical Research Center (US)
- University of Alabama at Birmingham (US)
- Bristol-Myers Squibb (United States) (US)
- Stanford University (US)
- Corresponding author
- Alten, Rieke
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2016-05-26
- Volume
- 17
- Issue
- 1
- Pages
- 231-231
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC4880815
- OpenAlex
- W2397253867
- Cited by
- 75
- References
- 51
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 7 · 2023: 4 · 2022: 11 · 2021: 19 · 2020: 8 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 2
- FWCI
- 7.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by)
- Funders
- Bristol-Myers Squibb
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Life Sciences › Immunology and Microbiology › Immunology › Immunotoxicology and immune responses
- Keywords
- rheumatoid arthritis, abatacept, pneumococcal polysaccharide vaccine, trivalent influenza vaccine, vaccine immunogenicity, antibody response, vaccine-preventable diseases, biologic therapy, disease-modifying antirheumatic drugs, vaccine safety and tolerability, protective antibody levels
- MeSH terms
- Abatacept, Adult, Antibodies, Bacterial, Antibodies, Viral, Arthritis, Rheumatoid, Female, Humans, Immunosuppressive Agents, Influenza, Human, Influenza Vaccines, Injections, Subcutaneous, Male, Middle Aged, Pneumococcal Infections, Vaccination, Antirheumatic Agents, Pneumococcal Vaccines
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