AB1152 INCREASED VACCINATION RATE AMONG PATIENTS UNDER BIOLOGICAL DMARDS AFTER INFECTIOUS RISK ASSESSMENT CLINIC
Authors: F. Cunha Santos, A. S. Pinto, S. P. Dinis, C. Quinaz, J. F. Ferreira, C. Vaz
Journal: Annals of the Rheumatic Diseases (2020)

Background: Infectious complications are a major concern among immunosuppressed patients. In an attempt to ameliorate these, EULAR released an updated version of their recommendations for vaccinations in patients with rheumatic diseases. These should resonate even further, since our patients are deliberately immunosuppressed in order to achieve remission. In 2018, an Infectious Risk Assessment Clinic (IRAC) was created in our centre to address these issues and prepare patients for biological therapy. This work summarizes our experience. Objectives: Compare vaccination rate among patients with rheumatic diseases under biological therapy before and after the clinic creation. Methods: A retrospective observational study was conducted in our Rheumatology Department and IRAC, at Local Health Unit of Guarda. All patients under biological therapy followed in our department from 2010 to 2020 were chart reviewed. Sociodemographic and clinical features were collected: sex, age, rheumatic disease diagnosis, current biological treatment and their vaccination history. Studied vaccines were Pneumococcal 13-valent conjugate, Pneumococcal vaccine polyvalent, Influenza virus, Hepatitis A and B, Herpes Zoster and Tetanus/Diphtheria. Patient was considered vaccinated when the correct schedule was followed by the attending physician. If prescription was outside the stipulated timing, it was considered not vaccinated. Chi-square and Fisher’s exact test were used to assess associations and p&lt;0.05 was considered statistically significant different. Results: 65 patients were included, 41 (63.10%) were females, with a mean age of 52.38±11.11 years. Diagnosis distribution is the following: rheumatoid arthritis (52.30%), axial spondylarthritis (26.20%), psoriatic arthritis (12.30%), peripheral spondylarthritis (6.20%), 1 (1.50%) patient with Sjögren Syndrome and 1 (1.50%) with systemic sclerosis. Most common drugs were anti-TNFα (64.60%), anti-JAK (15.40%), anti-IL17A (10.80%), anti-CD20 (7.70%) and anti-IL12/IL23 (1.50%). Of all patients, 24 (36.90%) attended IRAC before starting biological therapy. Table 1 shows prescribed vaccines in both groups and their associations. Table 1. Prescribed vaccines in both groups (p&lt;0.05). IRAC attended IRAC not attended P Pneumococcal 13-valent conjugate 0.24 Prescribed 23 (95.83%) 34 (82.93%) Not Prescribed 1 7 Pneumococcal vaccine polyvalent 0.01 Prescribed 19 (79.17%) 19 (46.34%) Not Prescribed 5 22 Influenza virus &lt;0.01 Prescribed 22 (91.67%) 12 (29.27%) Not Prescribed 2 29 Hepatitis A 0.05 Prescribed 3 (12.50%) 0 (0.00%) Not Prescribed 21 41 Hepatitis B Prescribed 12 (50.00%) 0 (0.00%) Not Prescribed 12 41 &lt;0.01 Herpes Zoster 0.37 Prescribed 1 (4.17%) 0 (0.00%) Not Prescribed 23 41 Tetanus/Diphtheria 0.14 Prescribed 3 (12.50%) 1 (2.44%) Not Prescribed 21 40 Conclusion: A few conclusions can be drawn from this work. Firstly, prevalence of vaccination increased after clinic creation, especially for Pneumococcal vaccine polyvalent, Influenza virus, Hepatitis A and B. We would expect the same results in the remaining vaccines in a broader population. Our results were also affected by stock rupture in our country. Secondly, this study shows the importance of a protocol, which helps systemise assessment of infectious risk before biological therapy, by analysing thoroughly vaccination history and keeping it updated. Lastly, shared responsibility between rheumatologists and infectiologists enables them to leverage their skills and focus, leading to ultimate gains for the patient. We hope this work motivates colleagues to start similar practices in their centres. References: [1]Furer, V., et al., 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis, 2020. 79 (1): p. 39-52. Disclosure of Interests: None declared