在接受非选择性或选择性JAK-i治疗的IMID患者中,对疹复合疫苗的免疫性差异
Cristiana Sieiro-Santos1,2,3,4, Juan Garcia Herrero5, Jose Ordas Martínez1
1Rheumatology Department, Complejo Asistencial Universitario de León, León, Spain.
Rheumatology (Oxford, England)
|October 16, 2025
概括
接受简氏激酶抑制剂 (JAK-is) 免疫媒介性炎症疾病 (IMID) 的患者对复合疫苗的免疫反应有所降低. 这表明与其他疗法相比,对疹病毒 (VZV) 再激活的保护性较低.
科学领域:
- 免疫学 免疫学 免疫学
- 疫苗学 疫苗学 疫苗学
- 类风湿病学 类风湿病学
背景情况:
- 患有免疫媒介性炎症疾病 (IMIDs) 的患者接受免疫抑制疗法,包括雅努斯激酶抑制剂 (JAK-is),面临感染风险增加.
- 重组杆菌疫苗推用于免疫功能低下的人,但其在JAK-is的IMID患者中的免疫性尚未得到充分证实.
- 麻疹病毒 (Varicella zoster virus,VZV) 的重新激活在接受JAK-is.治疗的患者中是一个令人担忧的问题.
研究的目的:
- 评估与JAK-is治疗的IMID患者对复合性疹疫苗的幽默和细胞免疫反应,而不是传统疗法 (抗TNF和/或甲醇).
- 为了比较接受泛JAK抑制剂和选择性JAK1抑制剂的患者之间的免疫反应.
- 确定与IMID患者疫苗诱导免疫力降低相关的临床因素.
主要方法:
- 在JAK-i治疗患者,抗TNF/MTX治疗患者和健康对照组中,比较免疫反应后的幽默性 (血清转化,IgG标位) 和细胞性 (CD4 T细胞,CD8 T细胞) 免疫反应.
- 评估了复合性无活化疹疫苗两剂疗法后的免疫反应.
- 分析了泛JAK抑制剂和选择性JAK1抑制剂之间的差异,以及与疫苗免疫性相关的临床因素.
主要成果:
- 与抗TNF/MTX患者 (91%) 和对照组 (100%) 相比,接受JAK抑制剂治疗的患者表现出明显较低的血清转化率 (74%) 和IgG标位.
- 与抗TNF/MTX患者 (67%和41%) 和对照患者 (95%和85%) 相比,JAK-i患者 (分别为28%和29%) 的细胞免疫反应 (CD4和CD8T细胞) 明显受损.
- 非选择性JAK抑制剂与选择性JAK1抑制剂相比,反应较差;免疫性与累积的葡萄糖皮质体/MTX剂量和JAK-i暴露时间负相关.
结论:
- 接受JAK抑制剂的IMID患者对复合性疹疫苗的幽默和细胞免疫反应显著受损,这表明对VZV重新激活的保护降低.
- 虽然用抗TNF/MTX治疗的患者的反应略有减少,但用JAK-i治疗的患者的抗体标位和T细胞反应明显降低.
- 不选择性JAK抑制剂的损伤更明显,突出了疫苗免疫性中的特定类别差异.
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