FRI0212 USE OF 23-VALENT POLYSACCHARIDE PNEUMOCOCCAL VACCINE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: THE RELATIONSHIP OF IMMUNOGENICITY WITH THERAPY
Authors: Galina Tarasova, Boris Belov, Daria Bukhanova, Maria Cherkasova, Sergey Solovyev, Elena Aseeva, Tatiana Reshetnyak, Tatiana Popkova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Immunization with pneumococcal vaccines is an important factor of the prevention of severe respiratory infections in patients with rheumatic diseases (RD). Vaccination in systemic lupus erythematosus (SLE) is designed to ensure the continuity of immunosuppressive therapy, reducing the risk of severe exacerbations and death, and is effective from a pharmaco-economical standpoint. <h3>Objectives</h3> Investigation of the immunogenicity of 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with SLE, as well as the effect of immunosuppressive therapy on the vaccinal response. <h3>Methods</h3> 34 patients with a reliable diagnosis of SLE (30 women and 4 men aged 19 to 68 years) were included. The duration of the disease varied from 9 months to 20 years. At the time of vaccination, 3 patients had high, 4 – moderate, 22 – low disease activity, and 5 were in remission. Current therapy: 33 patients received glucocorticoids (GC) 5-30 mg/day in prednisolone equivalent, 27 – hydroxychloroquine, 17 – cytotoxic agents (CA) (7 – mycophenolate mofetil, 6 – methotrexate, 1 – mycophenolic acid, 3 – azathioprine,2 - cyclophosphamide),11 – biologics (BS): 5-rituximab (RTM), 6– belimumab (BLM). RTM was administered in doses of 500-1000 mg every 6-12 months, BLM – from 400 to 720 mg every month. 0.5 ml of PPV-23 (1 dose) was administered subcutaneously. During the visits standard clinical and laboratory tests were performed, as well as determination of antibody (AB) to <i>S.pneumoniae</i> serum level with VaccZymeTMPCPIg 2 sets (TheBindingSiteLtd, Birmingham, UK). <h3>Results</h3> 1 and 3 months after vaccination, most patients (82,4% and 96,7% respectively) had a significant (more than 2 times compared to baseline) increase of the concentration of AB to the S. pneumoniae cell wall polysaccharides. A year after the vaccination, 22 (64.7%) patients (responders) had a significant increase of the concentration of anti-pneumococcal AB. 12 (35,3%) patients were considered as non-responders, they did not have a significant increase of the AB level (table). p a–b=0,000002; p a–c=0,00009; p a–d=0,0002. Among 11 patients receiving BS, a complete vaccinal response was observed much less frequently than in patients without these drugs, 36.4% and 78.3%, respectively, p=0.04. In the group treated with RTM, the number of non-responders was greater than among patients receiving BLM (80% and 50%, respectively), but this difference is not significant, p=0.6. The addition of CA to the treatment regimen did not have an additional negative effect on the vaccinal response. <h3>Conclusion</h3> Sufficient immunogenicity of PPV-23 was shown in patients with SLE, including those receiving combined immunosuppressive therapy. At the same time, the use of anti-B-cell drugs in combination therapy resulted in a significant decrease of the vaccinal response <h3>Disclosure of Interests</h3> None declared