POS0729 INFLUENCE OF VARIOUS FACTORS ON THE IMMUNOGENICITY OF 23-VALENT POLYSACCHARIDE PNEUMOCOCCAL VACCINE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: G. Tarasova, B. Belov, M. Cherkasova, E. Aseeva, T. Reshetnyak, N. Kosheleva, T. Popkova
Journal: Annals of the Rheumatic Diseases (2021)

Background: Immunosuppressive therapy increases the risk of pneumococcal infection in patients with systemic lupus erythematosus (SLE). The therapy, as well as some features of the course of the disease, can lead to a decrease in the immunogenicity of the pneumococcal vaccine in these patients. Objectives: The aim of the study was to identify “risk factors” that negatively affect the immunogenicity of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with SLE. Methods: The study included 60 patients aged 19 - 68 years with a reliable diagnosis of SLE, disease duration from 9 months. up to 42 years old. Nine patients had high disease activity, 12 had medium, 33 had low, and 6 had remission. Therapy: 58 patients received glucocorticoids (GC) 5-40 mg / day, 46-hydroxychloroquine, 33- cytostatics (CS), 23- biologics: 12-rituximab (RTM), 10-belimumab (BLM), 1- RTM and BLM. 1 dose (0.5 ml) of PPV-23 was administered subcutaneously. During the year, standard clinical and laboratory studies were carried out, the level of antibodies to polysaccharides of the S. pneumoniae cell wall in the blood serum was determined. Results: After 1-2 months. after vaccination, 78.7% of patients showed a more than twofold increase in protective antibodies, a year later - in 56.7% of patients (“responders”). The severity of the vac-cine response did not depend on age: in the subgroup of patients under 50 years of age (n = 46), the proportion of “responders” remained 52.2%, and in patients over 50 years of age (n = 14) -50%. With different duration of the disease, the vaccine response did not differ significantly: with a disease period of up to 5 years, the vaccine response was observed in 47.6%, from 5 to 10 years - in 66.7%, over 10 years - in 55.6% of patients. Patients in remission had the lowest vaccine response (33.3%), while with high SLE activity, 100% response to the vaccine was recorded (p = 0.02), which is probably due to the fact that remission requires long-term and active immunosuppressive therapy, and patients with high activity such therapy has just been initiated or is to be. With an average and low degree of activity, the number of “respondents” was the same (50% and 51.5%, respectively). In patients receiving biologics therapy, a full-fledged vaccine response was observed less frequently than in patients without biologics (39% and 68%, respectively, p = 0.03), while no differences were found against the background of RTM and BLM therapy (41.6% and 40% of “respondents”, respectively). The effect of the duration of biologics therapy on the severity of the vaccine response was analyzed. There was a tendency for the predominance of “responders” in the group with a duration of therapy before vaccination up to 1 year, as well as in the group of initiation of biologics after vaccination, however, the differences were not statistically significant. Conclusion: RTM and BLM have a negative effect on the immunogenicity of the PPV-23 vaccine. However, if the timing of administration is observed (initiation of biologics therapy after vaccination or vaccination against the background of biologics therapy lasting less than a year), the number of “responders” increases. Further recruitment of patients is needed to clarify and confirm the results obtained. Disclosure of Interests: None declared