SAT0063 THE COMBINED VACCINATION SCHEME AGAINST STREPTOCOCCUS PNEUMONIAE IS EFFECTIVE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH DMARD: DATA FROM BIOBADASER 3.0
Authors: S. C. Rodriguez-García, C. Sánchez-Piedra, R. Castellanos-Moreira, D. Ruiz-Montesinos, V. Hernandez, M. Pombo, F. Sánchez-Alonso, L. Carmona, J. J. Gómez-Reino
Journal: Annals of the Rheumatic Diseases (2020)

Background: Respiratory tract infections are among the leading causes of hospitalization in rheumatoid arthritis (RA) and Streptococcus Pneumoniae (Sp) is one of the most frequent pathogens involved. For these patients, the CDC recommends a combined vaccination scheme (CVS) using two types of Sp vaccines but evidence on its effectiveness remains insufficient.1 Objectives: To assess the impact of the combined vaccination scheme on the incidence of Sp infections in patients with RA treated with DMARD. Methods: A cohort was nested in a register including patients with RA who were prescribed a bDMARD or tsDMARD -either naïve or switch- from 2000 to March 2019. The target outcomes were invasive pneumococcal disease (IPD) and all-cause community-acquired pneumonia (CAP), as defined by relevant MedDRA codes. Demographic and clinical features were also retrieved. Each participant centre informed about the date when they implemented a systematic Sp vaccination protocol and whether they were using the CVS. Those not adopting this practice were excluded from the analysis. Crude incidence rates (IRs) were calculated for each outcome as well as for its combination (combined variable defined as “Sp infections”). Exposure was split into two periods, considering the date when the CVS was officially recommended in Spain (May 2015). The incidence rate ratio (IRR) comparing pre and post implementation periods was estimated with a Poisson regression model adjusted for sex, age and comorbidities (Charlson Index). Results: 1704 patients were included, their characteristics are shown in table 1. One centre was excluded for not using any Sp vaccination protocol while the remaining ones reported using the CVS. Crude IRs by periods (pre and post CVS implementation) and age groups are shown in table 2. The IRR of the post-vaccination period after adjusting for age, sex and comorbidities (Charlson index) was 0.40 (95% CI: 0.29 - 0.56), p&lt;0.001. Table 1. Baseline features of the cohort. Demographics Age, years * 60.6 (12.5) Female 1356 (79.6%) Current smoking 287 (16.8%) RA clinical characteristics Disease duration, years* 9.1 (7.9) RF positive 875 (74%) ACPA positive 831 (71%) DAS28* 4.6 (1.4) Other clinical characteristics Body Mass Index* 27.5 (5.2) Charlson index* 2.3 (1.5) Chronic pulmonary Disease 125 (9.3%) Diabetes mellitus 147 (9%) *Data presented as mean (standard deviation). Table 1 Characteristics of patients with RA at time of RA diagnosis and patients with SAB with/without RA at time of SAB diagnosis Characteristic, n (%) At RA diagnosis At first-time SAB RA (n=34,627) RA (n=228) Non-RA (n=25,268) Age, years (IQR) 59.8 (48.8-70.3) 71.8 (62.3-79.2) 69.7 (57.7-79.7) Female, % 69% 59% 38% Diabetes mellitus 2,467 (7.1%) 51 (22.4%) 5,678 (22.5%) Heart failure 1,018 (2.9%) 42 (18.4%) 4,718 (18.7%) Liver disease 454 (1.3%) 12 (5.3%) 2,189 (8.7%) Chronic obstructive pulmonary disease 1,677 (4.8%) 36 (15.8%) 3,412 (13.5%) Cancer 2,124 (6.1%) 60 (26.3%) 6,742 (26.7%) HIV 11 (0.0%) 0 (0%) 127 (0.5%) Solid organ transplant 8 (0.0%) 0 (0%) 357 (1.4%) Alcohol abuse 642 (1.9%) 12 (5.3%) 3,356 (13.3%) Chronic dialysis 29 (0.1%) 11 (4.8%) 2,256 (8.9%) Orthopedic implant 3,807 (11.0%) 89 (39.0%) 5,422 (21.5%) Cardiac or vascular implant 731 (2.1%) 18 (7.9%) 1,940 (7.7%) Glucocorticoid (0-90 days prior) 7,062 (20.4%) 99 (43.4 %) 2,911 (11.5%) Invasive surgery (0-30 days prior) 1,962 (5.7%) 62 (27.2%) 8,451 (33.5%) Table 2. Crude IRs (95% CI) of the outcomes of interest split by age. Overall &lt;65 ≥65 Pre Post Pre Post Pre Post SP-Infections 33 (27.4-39.9) 12.7 (9.8-16.4) 28 (22.4-35) 11.8 (8.9-15.6) 60.3 (42.4-85.8) 19.5 (10.8-35.2) IPD – 0.4 (0.1-1.6) – 0.4 (0.1-1.8) – – All cause CAP 23.6 (19.0-29.3) 11.5 (8.8-15) 18.7 (14.4-24.4) 10.4 (7.7-14) 50.8 (34.8-74) 19.5 (10.8-35.2) Conclusion: The incidence of Sp infections experienced a decrease in RA patients taking bDMARD or tsDMARD after the introduction of the stepwise combined vaccination scheme that is not related to age, sex or comorbidities. References: [1] Furer V, et al . Ann Rheum Dis 2019;0:1–14 Disclosure of Interests: Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp &amp; Dohme España, S.A., Sanofi Aventis, UCB Pharma, Carlos Sánchez-Piedra: None declared, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Dolores Ruiz-Montesinos: None declared, Victoria Hernandez: None declared, Manuel Pombo: None declared, Fernando Sánchez-Alonso: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp &amp; Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Juan Jesús Gómez-Reino: None declared