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Pneumococcal antibody levels after pneumovax in patients with rheumatoid arthritis on methotrexate
Elizabeth Coulson1, Vadivelu Saravanan, Jennifer Hamilton
1Department of Medicine and Rheumatology, Queen Elizabeth Hospital, Gateshead, UK.
Introduction:
Immunisation against pneumococcus has been shown to reduce pneumonia in rheumatoid arthritis (RA). There is concern that methotrexate may reduce its efficacy. There are very few objective data on the effect of methotrexate on the efficacy of pneumococcal vaccination with pneumovax, and no objective evidence on whether revaccination is necessary in RA patients on methotrexate.
Methods:
The authors collected information from 180 RA patients on methotrexate relating to their vaccination status and assayed their pneumococcal antibody levels. Data on pulmonary infection were retrieved in the same patients over the preceding decade.
Results:
Full data were available for 152 patients, of whom 28 had never been vaccinated against pneumococcus. Median levels were significantly higher in those who had been vaccinated. Unvaccinated patients and those taking oral prednisone were more likely to have had pneumonia in the previous 10 years. The RR for developing pneumonia among non-vaccinated patients was 9.7 (p=0.005) and among steroid-treated patients was 6.5 (p=0.001), after adjusting for age, gender, disease duration and comorbidity. No significant correlation was found between pneumococcal antibody levels and time since vaccination.
Conclusions:
This study suggests that a single administration of pneumovax early in RA offers up to 10 years protection against the development of pneumococcal pneumonia in RA patients on methotrexate.
Insights
Pneumococcal vaccination (Pneumovax) provides up to 10 years of protection against pneumonia in rheumatoid arthritis patients on methotrexate. Early vaccination is recommended for sustained efficacy and reduced pneumonia risk.
Area of Science:
- Rheumatology
- Immunology
- Infectious Diseases
Background:
- Rheumatoid arthritis (RA) patients are at increased risk of pneumococcal pneumonia.
- Methotrexate, a common RA treatment, may impact pneumococcal vaccine efficacy.
- Limited data exist on methotrexate's effect on pneumococcal vaccination effectiveness in RA.
Purpose of the Study:
- To assess the efficacy of pneumococcal vaccination (Pneumovax) in RA patients treated with methotrexate.
- To determine if revaccination is necessary for RA patients on methotrexate.
- To evaluate the duration of protection offered by pneumococcal vaccination.
Main Methods:
- Collected vaccination status and pneumococcal antibody levels from 180 RA patients on methotrexate.
- Retrieved pulmonary infection data for the preceding decade in the same patient cohort.
- Analyzed data from 152 patients with complete information.
Main Results:
- Vaccinated patients had significantly higher pneumococcal antibody levels.
- Unvaccinated patients had a 9.7-fold increased risk of pneumonia (p=0.005).
- Patients on oral prednisone had a 6.5-fold increased risk of pneumonia (p=0.001).
Conclusions:
- A single Pneumovax administration early in RA treatment offers up to 10 years of protection against pneumococcal pneumonia.
- This protection is observed in RA patients receiving methotrexate.
- Early vaccination is crucial for long-term defense against pneumococcal infections in this population.
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