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Sim TM, Lahiri M, Ma M, Cheung PPM, Mak A, Fong W, Angkodjojo S, Xu C, Kong KO, Arkachaisri T, Phang KF, Tan TC, Yap QV, Chan YH, Sriranganathan M, Chuah TY, Roslan NE, Poh YJ, Law A, Santosa A, Tay SH. Latent Class Analysis Identifies Distinct Phenotypes of Systemic Lupus Erythematosus Predictive of Flares after mRNA COVID-19 Vaccination: Results from the Coronavirus National Vaccine Registry for ImmuNe Diseases SINGapore (CONVIN-SING). Vaccines (Basel) 2023; 12:29. [PMID: 38250842 PMCID: PMC10819486 DOI: 10.3390/vaccines12010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
We recently reported that messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination was associated with flares in 9% of patients with systemic lupus erythematosus (SLE). Herein, we focused our analysis on patients from a multi-ethnic Southeast Asian lupus cohort with the intention of identifying distinct phenotypes associated with increased flares after mRNA COVID-19 vaccination. METHODS Six hundred and thirty-three SLE patients from eight public healthcare institutions were divided into test and validation cohorts based on healthcare clusters. Latent class analysis was performed based on age, ethnicity, gender, vaccine type, past COVID-19 infection, interruption of immunomodulatory/immunosuppressive treatment for vaccination, disease activity and background immunomodulatory/immunosuppressive treatment as input variables. Data from both cohorts were then combined for mixed effect Cox regression to determine which phenotypic cluster had a higher risk for time to first SLE flare, adjusted for the number of vaccine doses. RESULTS Two clusters were identified in the test (C1 vs. C2), validation (C1' vs. C2') and combined (C1″ vs. C2″) cohorts, with corresponding clusters sharing similar characteristics. Of 633 SLE patients, 88.6% were female and there was multi-ethnic representation with 74.9% Chinese, 14.2% Malay and 4.6% Indian. The second cluster (C2, C2' and C2″) was smaller compared to the first. SLE patients in the second cluster (C2 and C2') were more likely to be male, non-Chinese and younger, with higher baseline disease activity. The second cluster (C2″) had more incident flares (hazard ratio = 1.4, 95% confidence interval 1.1-1.9, p = 0.014) after vaccination. A higher proportion of patients in C2″ had immunomodulatory/immunosuppressive treatment interruption for vaccination as compared to patients in C1″ (6.6% vs. 0.2%) (p < 0.001). CONCLUSION We identified two distinct phenotypic clusters of SLE with different patterns of flares following mRNA COVID-19 vaccination. Caution has to be exercised in monitoring for post-vaccination flares in patients with risk factors for flares such as non-Chinese ethnicity, young age, male gender and suboptimal disease control at the time of vaccination.
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Affiliation(s)
- Tao Ming Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (T.M.S.)
| | - Manjari Lahiri
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Margaret Ma
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Peter Pak-Moon Cheung
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Warren Fong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Stanley Angkodjojo
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.X.)
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.X.)
| | - Thaschawee Arkachaisri
- Duke-NUS Medical School, Singapore 169857, Singapore;
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Kee Fong Phang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
- Chronic Programme, Alexandra Hospital, Singapore 159964, Singapore
| | - Teck Choon Tan
- Division of Rheumatology, Department of General Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (Q.V.Y.); (Y.H.C.)
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (Q.V.Y.); (Y.H.C.)
| | - Melonie Sriranganathan
- Division of Rheumatology, Department of Medicine, Changi General Hospital, Singapore 529889, Singapore
| | - Tyng Yu Chuah
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Nur Emillia Roslan
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Yih Jia Poh
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
| | - Annie Law
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
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Aikawa NE, Borba EF, Balbi VA, Sallum AME, Buscatti IM, Campos LMA, Kozu KT, Garcia CC, Capão ASV, de Proença ACT, Leon EP, da Silva Duarte AJ, Lopes MH, Silva CA, Bonfá E. Safety and immunogenicity of influenza A(H3N2) component vaccine in juvenile systemic lupus erythematosus. Adv Rheumatol 2023; 63:55. [PMID: 38017564 DOI: 10.1186/s42358-023-00339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION Seasonal influenza A (H3N2) virus is an important cause of morbidity and mortality in the last 50 years in population that is greater than the impact of H1N1. Data assessing immunogenicity and safety of this virus component in juvenile systemic lupus erythematosus (JSLE) is lacking in the literature. OBJECTIVE To evaluate short-term immunogenicity and safety of influenza A/Singapore (H3N2) vaccine in JSLE. METHODS 24 consecutive JSLE patients and 29 healthy controls (HC) were vaccinated with influenza A/Singapore/INFIMH-16-0019/2016(H3N2)-like virus. Influenza A (H3N2) seroprotection (SP), seroconversion (SC), geometric mean titers (GMT), factor increase in GMT (FI-GMT) titers were assessed before and 4 weeks post-vaccination. Disease activity, therapies and adverse events (AE) were also evaluated. RESULTS JSLE patients and controls were comparable in current age [14.5 (10.1-18.3) vs. 14 (9-18.4) years, p = 0.448] and female sex [21 (87.5%) vs. 19 (65.5%), p = 0.108]. Before vaccination, JSLE and HC had comparable SP rates [22 (91.7%) vs. 25 (86.2%), p = 0.678] and GMT titers [102.3 (95% CI 75.0-139.4) vs. 109.6 (95% CI 68.2-176.2), p = 0.231]. At D30, JSLE and HC had similar immune response, since no differences were observed in SP [24 (100%) vs. 28 (96.6%), p = 1.000)], SC [4 (16.7%) vs. 9 (31.0%), p = 0.338), GMT [162.3 (132.9-198.3) vs. 208.1 (150.5-287.8), p = 0.143] and factor increase in GMT [1.6 (1.2-2.1) vs. 1.9 (1.4-2.5), p = 0.574]. SLEDAI-2K scores [2 (0-17) vs. 2 (0-17), p = 0.765] and therapies remained stable throughout the study. Further analysis of possible factors influencing vaccine immune response among JSLE patients demonstrated similar GMT between patients with SLEDAI < 4 compared to SLEDAI ≥ 4 (p = 0.713), as well as between patients with and without current use of prednisone (p = 0.420), azathioprine (p = 1.0), mycophenolate mofetil (p = 0.185), and methotrexate (p = 0.095). No serious AE were reported in both groups and most of them were asymptomatic (58.3% vs. 44.8%, p = 0.958). Local and systemic AE were alike in both groups (p > 0.05). CONCLUSION This is the first study that identified adequate immune protection against H3N2-influenza strain with additional vaccine-induced increment of immune response and an adequate safety profile in JSLE. ( www. CLINICALTRIALS gov , NCT03540823).
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Affiliation(s)
- Nadia Emi Aikawa
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Eduardo Ferreira Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Verena Andrade Balbi
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil
| | - Adriana Maluf Elias Sallum
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil
| | - Izabel Mantovani Buscatti
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil
| | - Kátia Tomie Kozu
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil
| | - Cristiana Couto Garcia
- Laboratory of Respiratory, Exanthematic Viruses, Enterovirus and Viral Emergencies, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Integrated Research Group On Biomarkers. René Rachou Institute, FIOCRUZ Minas, Belo Horizonte, MG, Brazil
| | - Artur Silva Vidal Capão
- Laboratory of Respiratory, Exanthematic Viruses, Enterovirus and Viral Emergencies, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Adriana Coracini Tonacio de Proença
- Department of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Elaine Pires Leon
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alberto José da Silva Duarte
- Clinical Laboratory Division - Department of Pathology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marta Heloisa Lopes
- Department of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3Rd Floor, room 3190 - Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Jain N, Kourampi I, Umar TP, Almansoor ZR, Anand A, Ur Rehman ME, Jain S, Reinis A. Global population surpasses eight billion: Are we ready for the next billion? AIMS Public Health 2023; 10:849-866. [PMID: 38187896 PMCID: PMC10764969 DOI: 10.3934/publichealth.2023056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 01/09/2024] Open
Abstract
In November 2022, the global population had officially crossed eight billion. It has long been recognized that socioeconomic or health-related problems in the community always accompany an uncontrolled population expansion. International calls have been made regarding lack of universal health coverage, an insufficient supply of healthcare providers, the burden of noncommunicable disease, population aging and the difficulty in obtaining safe drinking water and food. The present health policy paper discusses how to conquer these crowded world issues, including (1) promoting government and international organization participation in providing appropriate infrastructure, funding and distribution to assist people's health and well-being; (2) shifting health program towards a more preventive approach and (3) reducing inequalities, particularly for the marginalized, isolated and underrepresented population. These fundamental principles of health policy delivery as a response to an increasingly crowded world and its challenges are crucial for reducing the burden associated with excessive healthcare costs, decreased productivity and deteriorating environmental quality.
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Affiliation(s)
- Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, 16 Dzirciema street, Riga, Latvia, LV-1007
| | - Islam Kourampi
- Department of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece, 11527
| | - Tungki Pratama Umar
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia 30128
| | - Zahra Rose Almansoor
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Buddha Road, Dharan 56700, Nepal
| | | | - Shivani Jain
- Department of Oral and Maxillofacial Surgery, Genesis Institute of Dental Sciences & Research, Ferozepur-Moga Road, Ferozepur, Punjab, India 152002
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradinš University, 16 Dzirciema street, Riga, Latvia, LV-1007
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Tunitsky-Lifshitz Y, Maoz-Segal R, Niznik S, Shavit R, Haj Yahia S, Langevitz P, Agmon-Levin N. The third dose of BNT162b2 COVID-19 vaccine is efficacious and safe for systemic lupus erythematosus patients receiving belimumab. Lupus 2023; 32:675-679. [PMID: 36952594 PMCID: PMC10037128 DOI: 10.1177/09612033231164262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Over 95% of healthy subjects develop anti-COVID IgG antibodies after receiving two doses of BNT162b2 COVID-19 vaccine. In comparison, 20%-30% of SLE patients do not seroconvert following 1-2 doses of COVID vaccines, potentially due to immunosuppression. The aim of this study was to assess immunogenicity and safety of BNT vaccine in SLE patients treated with Belimumab and especially the yield of a booster third dose in this population. METHODS SLE patients treated with Belimumab in the Sheba Medical Center, Israel, were included in this study. All were recommended to receive the BNT vaccine according to national guidelines; and were advised to perform serologic tests after receiving second and third doses. Clinical data included demographics, SLE treatments, adverse effects to vaccines and SLEDAI scores performed 2 weeks before vaccinations and 6-12 weeks after receiving the second or third dose of the vaccine. RESULTS Our cohort included 17 patients, 14 (82.35%) females, median age 50 ± 14.2 years, and disease duration 12 ± 10.57 years. Belimumab therapy was given for a mean of 6 ± 2.5 years. Of them, 15/17 patients received 3-doses of BNT vaccine. Serologic assessment was performed for 10 patients, 7/10(70%) became seropositive following the second dose, while 2/3 patients seroconverted only after the third dose. Vaccinations were well tolerated with minimal adverse events and no disease flares. SLEDAI scores before and after vaccinations were 4 ± 3.8 and 4 ± 2.7 (p = 0.69), respectively. CONCLUSIONS Immunization with the BNT vaccine is efficacious and safe for SLE patients treated with Belimumab. Following the third dose of vaccine, immunogenicity among SLE patients mounted to 90%, thereby approximating the general healthy population. No SLE disease flares and/or significant adverse events were noted in our cohort. Assessment of seroconversion and consideration of subsequent boosters of COVID-vaccine should be considered in this group of patients.
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Affiliation(s)
- Yulia Tunitsky-Lifshitz
- Clinical Immunology, Angioedema and Allergy Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Ramit Maoz-Segal
- Clinical Immunology, Angioedema and Allergy Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
| | - Stanley Niznik
- Clinical Immunology, Angioedema and Allergy Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
| | - Ronen Shavit
- Clinical Immunology, Angioedema and Allergy Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
| | - Soad Haj Yahia
- Clinical Immunology, Angioedema and Allergy Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Pnina Langevitz
- Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
- Rheumatology Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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Massaro MG, Caldarelli M, Franza L, Candelli M, Gasbarrini A, Gambassi G, Cianci R, Rigante D. Current Evidence on Vaccinations in Pediatric and Adult Patients with Systemic Autoinflammatory Diseases. Vaccines (Basel) 2023; 11:vaccines11010151. [PMID: 36679996 PMCID: PMC9860706 DOI: 10.3390/vaccines11010151] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Systemic autoinflammatory diseases (SAIDs) are defined by recurrent febrile attacks associated with protean manifestations involving joints, the gastrointestinal tract, skin, and the central nervous system, combined with elevated inflammatory markers, and are caused by a dysregulation of the innate immune system. From a clinical standpoint, the most known SAIDs are familial Mediterranean fever (FMF); cryopyrin-associated periodic syndrome (CAPS); mevalonate kinase deficiency (MKD); and periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) syndrome. Current guidelines recommend the regular sequential administration of vaccines for all individuals with SAIDs. However, these patients have a much lower vaccination coverage rates in 'real-world' epidemiological studies than the general population. The main purpose of this review was to evaluate the scientific evidence available on both the efficacy and safety of vaccines in patients with SAIDs. From this analysis, neither serious adverse effects nor poorer antibody responses have been observed after vaccination in patients with SAIDs on treatment with biologic agents. More specifically, no new-onset immune-mediated complications have been observed following immunizations. Post-vaccination acute flares were significantly less frequent in FMF patients treated with colchicine alone than in those treated with both colchicine and canakinumab. Conversely, a decreased risk of SARS-CoV-2 infection has been proved for patients with FMF after vaccination with the mRNA-based BNT162b2 vaccine. Canakinumab did not appear to affect the ability to produce antibodies against non-live vaccines in patients with CAPS, especially if administered with a time lag from the vaccination. On the other hand, our analysis has shown that immunization against Streptococcus pneumoniae, specifically with the pneumococcal polysaccharide vaccine, was associated with a higher incidence of adverse reactions in CAPS patients. In addition, disease flares might be elicited by vaccinations in children with MKD, though no adverse events have been noted despite concurrent treatment with either anakinra or canakinumab. PFAPA patients seem to be less responsive to measles, mumps, and rubella-vaccine, but have shown higher antibody response than healthy controls following vaccination against hepatitis A. In consideration of the clinical frailty of both children and adults with SAIDs, all vaccinations remain 'highly' recommended in this category of patients despite the paucity of data available.
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Affiliation(s)
- Maria Grazia Massaro
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Mario Caldarelli
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Laura Franza
- Emergency Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marcello Candelli
- Emergency Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanni Gambassi
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Correspondence:
| | - Donato Rigante
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Marinho A, Delgado Alves J, Fortuna J, Faria R, Almeida I, Alves G, Araújo Correia J, Campar A, Brandão M, Crespo J, Marado D, Matos-Costa J, Oliveira S, Salvador F, Santos L, Silva F, Fernandes M, Vasconcelos C. Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren's syndrome: evidence- and practice-based guidance. Front Immunol 2023; 14:1117699. [PMID: 37138867 PMCID: PMC10150407 DOI: 10.3389/fimmu.2023.1117699] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren's syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS.
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Affiliation(s)
- António Marinho
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- *Correspondence: António Marinho,
| | - José Delgado Alves
- Systemic Autoimmune Diseases Unit, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
- Immune Response and Vascular Disease Unit - iNOVA4Health, NOVA Medical School, Lisboa, Portugal
| | - Jorge Fortuna
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Faria
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Almeida
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Glória Alves
- Serviço de Medicina Interna, Hospital da Senhora da Oliveira - Centro Hospitalar Alto Ave, Guimarães, Portugal
| | - João Araújo Correia
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Campar
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Mariana Brandão
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jorge Crespo
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Daniela Marado
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - João Matos-Costa
- Serviço de Medicina Interna, Hospital Distrital de Santarém, Santarém, Portugal
| | - Susana Oliveira
- Systemic Autoimmune Diseases Unit, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Fernando Salvador
- Unidade de Doenças Autoimunes, Serviço de Medicina Interna, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Lelita Santos
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Linha de Investigação Clínica e Interdisciplinar em Meio Ambiente, Genética e Oncobiologia (CIMAGO), Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Fátima Silva
- Serviço de Medicina Interna, Departamento de Medicina, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Milene Fernandes
- Real-World Evidence & Late Phase, CTI Clinical Trial & Consulting Services Unipessoal Lda, Lisboa, Portugal
| | - Carlos Vasconcelos
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal
- UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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7
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Murdaca G, Noberasco G, Olobardi D, Ogliastro M, Sibilio R, Sambuceti G, Balzano R, Sticchi L, Icardi G, Orsi A. Systemic sclerosis and vaccinations: a three-year register-based cohort study about vaccination rate and uptake from Liguria referral center, northwest Italy. Hum Vaccin Immunother 2022; 18:2025732. [PMID: 35258440 PMCID: PMC8993060 DOI: 10.1080/21645515.2022.2025732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Patients with diffused Systemic Sclerosis (dSSc) are more subject to severe respiratory complications with higher rates of intensive care unit (ICU) admission. Vaccination represents the most effective means of prevention and care for frail patients, such as SSc patients, preventing infections, reducing mortality and morbidity, and granting a better quality of life. Both vaccinations against seasonal influenza and Streptococcus pneumoniae are currently recommended by the European League Against Rheumatism (EULAR) guidelines on vaccination. The aim of this study is to give an updated analysis on S. pneumoniae and seasonal influenza vaccination coverage in a cohort of 91 patients with SSc and to investigate demographic and clinical variables significantly related to vaccine acceptance. The correlation between vaccine administration and other factors was investigated using a binomial logistic regression to evaluate the adjusted odds ratio (aOR). The patients followed up in this study reached higher percentages than the general population, passing the 75% target for both influenza and anti-pneumococcal vaccinations and reaching for influenza vaccine coverage rates of 83.8% for subjects undergoing immunosuppressive therapies and 88.9% for elderly subjects. For the latter group, it is important to emphasize the strong correlation between older age groups and vaccination acceptance.
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Affiliation(s)
- Giuseppe Murdaca
- Departments of Internal Medicine, University of Genova, Genova, Italy
| | - Giovanni Noberasco
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy
| | - Dario Olobardi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy
| | - Matilde Ogliastro
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy
| | - Raffaella Sibilio
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy
| | - Giacomo Sambuceti
- Departments of Internal Medicine, University of Genova, Genova, Italy
| | - Riccardo Balzano
- Departments of Internal Medicine, University of Genova, Genova, Italy
| | - Laura Sticchi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy.,Hygiene Unit, "Ospedale Policlinico San Martino IRCCS", Genova, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy.,Hygiene Unit, "Ospedale Policlinico San Martino IRCCS", Genova, Italy
| | - Andrea Orsi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, Genova, Italy.,Hygiene Unit, "Ospedale Policlinico San Martino IRCCS", Genova, Italy
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8
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Nguyen PTN, Le NV, Dinh HMN, Nguyen BQP, Nguyen TVA. Lung penetration and pneumococcal target binding of antibiotics in lower respiratory tract infection. Curr Med Res Opin 2022; 38:2085-2095. [PMID: 36189961 DOI: 10.1080/03007995.2022.2131304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To achieve the therapeutic effects, antibiotics must penetrate rapidly into infection sites and bind to targets. This study reviewed updated knowledge on the ability of antibiotics to penetrate into the lung, their physicochemical properties influencing the pulmonary penetration and their ability to bind to targets on pneumococci. METHODS A search strategy was developed using PubMED, Web of Science, and ChEMBL. Data on serum protein binding, drug concentration, target binding ability, drug transporters, lung penetration, physicochemical properties of antibiotics in low respiratory tract infection (LRTI) were collected. RESULTS It was seen that infection site-to-serum concentration ratios of most antibiotics are >1 at different time points except for ceftriaxone, clindamycin and vancomycin. Most agents have proper physicochemical properties that facilitate antibiotic penetration. In antimicrobial-resistant Streptococcus pneumoniae, the binding affinity of antibiotics to targets mostly decreases compared to that in susceptible strains. The data on binding affinity of linezolid, clindamycin and vancomycin were insufficient. The higher drug concentration at the infection sites compared to that in the blood can be associated with inflammation conditions. Little evidence showed the effect of drug transporters on the clinical efficacy of antibiotics against LRTI. CONCLUSIONS Data on antibiotic penetration into the lung in LRTI patients and binding affinity of antibiotics for pneumococcal targets are still limited. Further studies are required to clarify the associations of the lung penetration and target binding ability of antibitotics with therapeutic efficacy to help propose the right antibiotics for LRTI.
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Affiliation(s)
| | - Nho Van Le
- Danang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | | | | | - Thi Van Anh Nguyen
- Department of Life Sciences, University of Science and Technology of Hanoi (USTH), Vietnam Academy of Science and Technology (VAST), Hanoi, Vietnam
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9
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Ongoing Mycophenolate Treatment Impairs Anti-SARS-CoV-2 Vaccination Response in Patients Affected by Chronic Inflammatory Autoimmune Diseases or Liver Transplantation Recipients: Results of the RIVALSA Prospective Cohort. Viruses 2022; 14:v14081766. [PMID: 36016388 PMCID: PMC9413351 DOI: 10.3390/v14081766] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/21/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccines are the most effective means to prevent the potentially deadly effects of SARS-CoV-2 infection, but not all vaccinated individuals gain the same degree of protection. Patients undergoing chronic immunosuppressive therapy due to autoimmune diseases or liver transplants, for example, may show impaired anti-SARS-CoV-2 antibody response after vaccination. We performed a prospective observational study with parallel arms, aiming to (a) evaluate seroconversion after anti-SARS-CoV-2 mRNA vaccine administration in different subgroups of patients receiving immunosuppressive treatment for rheumatological or autoimmune diseases or to prevent organ rejection after liver transplantation and (b) identify negative predictors of IgG anti-SARS-CoV-2 development. Out of 437 eligible patients, 183 individuals were enrolled at the Rheumatology and Hepatology Tertiary Units of “Maggiore della Carità” University Hospital in Novara: of those, 52 were healthy subjects, while among the remaining 131 patients, 30 had a diagnosis of spondyloarthritis, 25 had autoimmune hepatitis, 10 were liver transplantation recipients, 23 suffered from connective tissue diseases (including 10 cases that overlapped with other diseases), 40 were treated for rheumatoid arthritis, and 5 had vasculitis. Moreover, all patients were receiving chronic immunosuppressive therapy. The immunogenicity of mRNA COVID-19 vaccines was evaluated by measuring IgG anti-SARS-CoV-2 antibody titers before vaccination and after 10, 30, and 90 days since the first dose administration. Of the selected cohort of patients, 24.0% did not develop any detectable anti-SARS-CoV-2 IgG after a complete mRNA-based two doses primary vaccination cycle. At univariate analysis, independent predictors of an absent antibody response to vaccine were a history of liver transplantation (OR 11.5, 95% CI 2.5−53.7, p = 0.0018), the presence of a comorbid active neoplasia (OR 26.4, 95% CI 2.8−252.4, p = 0.0045), and an ongoing immunosuppressive treatment with mycophenolate (MMF) (OR 14.0, 95% CI 3.6−54.9, p = 0.0002) or with calcineurin inhibitors (OR 17.5, 95% CI 3.1−99.0, p = 0.0012). At multivariate analysis, only treatment with MMF (OR 24.8, 95% CI 5.9−103.2, p < 0.0001) and active neoplasia (OR 33.2, 95% CI 5.4−204.1, p = 0.0002) were independent predictors of seroconversion failure. These findings suggest that MMF dose reduction or suspension may be required to optimize vaccine response in these patients.
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10
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Aberrant Cellular Glycosylation May Increase the Ability of Influenza Viruses to Escape Host Immune Responses through Modification of the Viral Glycome. mBio 2022; 13:e0298321. [PMID: 35285699 PMCID: PMC9040841 DOI: 10.1128/mbio.02983-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Individuals with metabolic dysregulation of cellular glycosylation often experience severe influenza disease, with a poor immune response to the virus and low vaccine efficacy. Here, we investigate the consequences of aberrant cellular glycosylation for the glycome and the biology of influenza virus. We transiently induced aberrant N-linked glycosylation in cultured cells with an oligosaccharyltransferase inhibitor, NGI-1. Cells treated with NGI-1 produced morphologically unaltered viable influenza virus with sequence-neutral glycosylation changes (primarily reduced site occupancy) in the hemagglutinin and neuraminidase proteins. Hemagglutinin with reduced glycan occupancy required a higher concentration of surfactant protein D (an important innate immunity respiratory tract collectin) for inhibition compared to that with normal glycan occupancy. Immunization of mice with NGI-1-treated virus significantly reduced antihemagglutinin and antineuraminidase titers of total serum antibody and reduced hemagglutinin protective antibody responses. Our data suggest that aberrant cellular glycosylation may increase the risk of severe influenza as a result of the increased ability of glycome-modified influenza viruses to evade the immune response.
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11
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Current Take on Systemic Sclerosis Patients' Vaccination Recommendations. Vaccines (Basel) 2021; 9:vaccines9121426. [PMID: 34960174 PMCID: PMC8708328 DOI: 10.3390/vaccines9121426] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune inflammatory rheumatic disease. The prevalence of SSc ranges from 7 to 700 cases per million worldwide. Due to multiple organ involvement and constant inflammatory state, this group of patients presents an increased risk of infectious diseases. This paper aimed to gather the up-to-date evidence on vaccination strategies for patients with SSc and to be a useful tool for the prevention and management of infectious diseases. The authors conducted a scoping review in which each paragraph presents data on a specific vaccine’s safety, immunogenicity, and efficacy. The work deals with the following topics: SARS-CoV-2, seasonal influenza, S. pneumoniae, HAV, HBV, HZV, N. meningitidis, H. influenzae, HPV, and diphtheria-tetanus-pertussis.
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12
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Fortunato F, Martinelli D, Lopalco PL, Prato R. Safety evaluation of the DTaP5-IPV-Hib-HepB vaccine: a review. Expert Opin Drug Saf 2021; 21:295-302. [PMID: 34787536 DOI: 10.1080/14740338.2022.2007882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The DTaP5-IPV-Hib-HepB vaccine is the most recently approved combination hexavalent vaccine. In Europe, it is licensed since 2016 for primary and booster vaccination in infants and toddlers above the age of 6 weeks to provide active immunization against diphtheria, tetanus, pertussis, poliomyelitis, invasive diseases caused by Haemophilus influenzae type b and hepatitis B. In the US, DTaP5-IPV-Hib-HepB is approved since 2018 in children 6 weeks through 4 years of age. Its safety profile has been extensively documented in infants and children born at term, and also data in preterm infants are made available. AREAS COVERED In this article, we conducted a safety evaluation of the DTaP5-IPV-Hib-HepB vaccine in infants and toddlers considering evidence from clinical trials and post-marketing use, also with regard to data on special populations e.g. preterm infants. EXPERT OPINION Based on the available data, the DTaP5-IPV-Hib-HepB vaccine has demonstrated a good safety profile, similar to that of other approved penta- and hexavalent vaccines. Rather, post-marketing data are limited and are frequently reported in combination with other hexavalent vaccines or are not adjusted for shares of vaccines use. Neither relevant interferences with other co-administered pediatric vaccines nor safety issues in premature infants have been shown.
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Affiliation(s)
- Francesca Fortunato
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Martinelli
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Rosa Prato
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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13
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Side effects and flares risk after SARS-CoV-2 vaccination in patients with systemic lupus erythematosus. Clin Rheumatol 2021; 41:1349-1357. [PMID: 34782941 PMCID: PMC8592807 DOI: 10.1007/s10067-021-05980-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/18/2021] [Accepted: 10/31/2021] [Indexed: 12/14/2022]
Abstract
The objective of this study is to identify post SARS-CoV-2 vaccine BNT162b2 (BioNTech & Pfizer) side effects in patients with systemic lupus erythematosus (SLE) at the Cayetano Heredia Hospital, Lima, Peru. A descriptive observational study was designed in patients with SLE at the Immuno-Rheumatology Department of the Cayetano Heredia Hospital, Lima, Peru, immunized with the BNT162b2 vaccine from May 21 to June 30, 2021. Of the total number of patients seen in the service, 100 received the vaccine’s 1st dose, and 90 patients received the 2nd dose; 90% and 92.2% presented symptoms within 10 days after immunization (1st and 2nd doses, respectively), being pain at the inoculation site the most frequent (87%); most of the symptoms presented were of mild intensity. There were 27 episodes of post-immunization flare, 9% and 20% after the 1st and 2nd doses, respectively; the predominant type of flare was articular (85.1%), followed by dermal (18.5%). It was found that a history of renal involvement was associated with the risk of developing flare RR 0.38 (0.15–0.91) and the use of hydroxychloroquine and azathioprine prior to immunization 0.20 (0.06–0.63) and 7.96 (2.70–23.43) respectively. In 100 SLE patients immunized with BNT162b2 vaccine against SARS-CoV-2, 27% of SLE reactivation episodes occurred, two patients were hospitalized for flare severity, and none died.Key Points • Up to 92.2% presented some type of symptom after vaccination, being mostly local and of mild intensity. • Of the population studied, there were 27 episodes of post-vaccination flare, most of which were mild. • In the studied population, taking hydroxychloroquine and having a history of renal disease were associated with a lower risk of presenting post-vaccination flare. |
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14
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Guerrini G, Vivi A, Gioria S, Ponti J, Magrì D, Hoeveler A, Medaglini D, Calzolai L. Physicochemical Characterization Cascade of Nanoadjuvant-Antigen Systems for Improving Vaccines. Vaccines (Basel) 2021; 9:vaccines9060544. [PMID: 34064212 PMCID: PMC8224364 DOI: 10.3390/vaccines9060544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/09/2021] [Accepted: 05/17/2021] [Indexed: 01/25/2023] Open
Abstract
Adjuvants have been used for decades to enhance the immune response to vaccines, in particular for the subunit-based adjuvants. Physicochemical properties of the adjuvant-protein antigen complexes, such as size, morphology, protein structure and binding, influence the overall efficacy and safety of the vaccine. Here we show how to perform an accurate physicochemical characterization of the nanoaluminum-ovalbumin complex. Using a combination of existing techniques, we developed a multi-staged characterization strategy based on measurements of increased complexity. This characterization cascade has the advantage of being very flexible and easily adaptable to any adjuvant-protein antigen combinations. It will contribute to control the quality of antigen-adjuvant complexes and immunological outcomes, ultimately leading to improved vaccines.
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Affiliation(s)
- Giuditta Guerrini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.G.); (A.V.); (D.M.)
| | - Antonio Vivi
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.G.); (A.V.); (D.M.)
| | - Sabrina Gioria
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.G.); (J.P.); (D.M.); (A.H.)
| | - Jessica Ponti
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.G.); (J.P.); (D.M.); (A.H.)
| | - Davide Magrì
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.G.); (J.P.); (D.M.); (A.H.)
| | - Arnd Hoeveler
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.G.); (J.P.); (D.M.); (A.H.)
| | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.G.); (A.V.); (D.M.)
| | - Luigi Calzolai
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.G.); (J.P.); (D.M.); (A.H.)
- Correspondence:
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15
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Akmatov MK, Holstiege J, Steffen A, Bätzing J. Utilization of influenza vaccination among chronically ill individuals in Germany: A nationwide claims-based analysis. Vaccine 2021; 39:952-960. [PMID: 33451775 DOI: 10.1016/j.vaccine.2020.12.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals with chronic diseases have a higher risk of serious complications or even death in case of influenza infection. The European Union (EU) set a goal to reach a vaccination coverage of 75% in seniors and chronically ill individuals. The aim of this study was to assess influenza vaccination uptake among individuals with a wide spectrum of chronic diseases and examine its regional variations and temporal trends over a period of the last ten years. METHODS We used nationwide SHI-physician outpatient claims data from the years 2009 to 2018 covering 87% of the total German population to assess influenza vaccination uptake among individuals over 1 year of age with at least one of the following chronic diseases: pulmonary, cardiovascular, liver, kidney, metabolic, neurological and musculoskeletal diseases, as well as immune deficiency disorders, including HIV infection. RESULTS Influenza vaccination coverage varied across patient populations between 19% (multiple sclerosis) and 44% (chronic kidney disease) in the influenza season 2017/18. Vaccination coverage was slightly higher among females than males, except for HIV/AIDS patients. Among HIV-patients vaccination coverage was higher by 7 percent points among males (43%) than females (37%). The coverage was higher nearly for all patient groups in the eastern than western federal states. Over the observation period vaccination uptake showed decreasing trends in most of the target groups. Among patients with HIV/AIDS and immune deficiency disorders a stagnating trend was observed. CONCLUSIONS Vaccination uptake among chronically ill individuals is suboptimal and far from the EU-defined target of 75%. There were substantial variations in coverage by disease groups, individual factors and regions. The disease-specific evaluation of the current study allows identification of populations at higher risk with considerable vaccination gaps. Further efforts are needed to improve vaccination uptake in these vulnerable population groups.
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Affiliation(s)
- Manas K Akmatov
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany.
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany
| | - Annika Steffen
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany
| | - Jörg Bätzing
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany
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Singh JA, Cleveland JD. Hospitalized Infections in Lupus: A Nationwide Study of Types of Infections, Time Trends, Health Care Utilization, and In-Hospital Mortality. Arthritis Rheumatol 2020; 73:617-630. [PMID: 33142044 DOI: 10.1002/art.41577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/29/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the time trends in hospitalized infections in patients with systemic lupus erythematosus (SLE), and the factors associated with health care utilization and in-hospital mortality. METHODS US National Inpatient Sample data from 1998-2016 were used to examine the epidemiology, time trends, and outcomes of 5 common hospitalized infections in patients with SLE, namely, pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), and opportunistic infections (OIs). Time trends were compared using the Cochran-Armitage test. Multivariable-adjusted logistic regression models were used to examine the factors associated with health care utilization (hospital stay >3 days, hospital charges above the median, or discharge to a nonhome setting) and in-hospital mortality. RESULTS Hospitalization rates per 100,000 claims among SLE patients in 1998-2000 versus in 2015-2016 were as follows: for OIs, 1.13 versus 1.61 (1.2-fold increase); for SSTIs, 4.78 versus 12.2 (2.5-fold increase); for UTI, 1.94 versus 6.12 (3.2-fold increase); for pneumonia, 15.09 versus 17.05 (1.1-fold increase); and for sepsis, 6.31 versus 39.64 (6.3-fold increase). In 2011-2012, sepsis surpassed pneumonia as the most common hospitalized infection in patients with SLE. In multivariable-adjusted models, a diagnosis of sepsis, older age, a Deyo-Charlson common comorbidities score of ≥2, having Medicare or Medicaid insurance, and urban hospital location were significantly associated with increased odds of in-hospital mortality and with all health care utilization outcomes. African American race was significantly associated with increased odds of health care utilization. CONCLUSION The results of this study indicate that the rates of hospitalized infections increased over time in patients with SLE, and that pneumonia was surpassed by sepsis as the most common hospitalized infection. In addition, associations of risk factors with poorer outcomes were identified. These findings may help inform patients, providers, and policy makers with regard to the burden of infection in SLE, and could lead to interventions/pathways to improve outcomes.
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Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham VA Medical Center
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Scott-Charlton A, Reynolds G. A case of systemic lupus erythematosus associated auto-splenectomy presenting as invasive pneumococcal sepsis. Mod Rheumatol Case Rep 2020; 4:233-236. [PMID: 33087009 DOI: 10.1080/24725625.2020.1751407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 21-year-old female with a history of systemic lupus erythematosus (SLE) presented to the emergency department with septic shock. She had been maintained on 5 mg prednisolone daily and hydroxychloroquine 400 mg once daily and been investigated three years prior for recurrent left upper quadrant chest pain. Her previous SLE complications included pericardial effusion and high-risk pregnancy. Intensive care support was required due to septic shock, and a diagnosis of primary invasive Streptococcus pneumoniae bacteraemia was made following positive blood cultures. Computer tomography imaging of the abdomen demonstrated asplenia, with a diagnosis of auto-splenectomy thought most likely. Retrospective analysis of blood films from the two years prior was consistent with hyposplenism, including Howell-Jolly Bodies. The patient recovered from her sepsis and is maintained on amoxicillin prophylaxis. She was vaccinated according to post splenectomy guidelines and registered to the spleen registry. We report a case of auto-splenectomy and subsequent invasive pneumococcal disease in a SLE patient.
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Affiliation(s)
- Adam Scott-Charlton
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.,Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia
| | - Gemma Reynolds
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
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18
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Gerard AL, Goulenok T, Bahuaud M, Francois C, Aucouturier P, Moins-Teisserenc H, Batteux F, Papo T, Sacre K. Serum IgG2 levels predict long-term protection following pneumococcal vaccination in systemic lupus erythematosus (SLE). Vaccine 2020; 38:6859-6863. [PMID: 32896468 DOI: 10.1016/j.vaccine.2020.08.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 01/27/2023]
Abstract
Systemic lupus erythematosus (SLE) patients are at risk for pneumococcal infection. Twenty-one consecutive SLE patients (40[25-75] years) received the sequential PCV13/PPSV23 vaccine and factors associated with long-term protection were analyzed. Immune protection, defined by an antigen-specific IgG concentration ≥1.3 µg/mL for at least 70% of 7 pneumococcal serotypes was assessed at baseline, 2, 6, 12 and 36 months defining long-term protection. Only 10 patients showed pneumococcal immune protection 36 months after vaccination. Eleven (52.4%) patients had no long-term protection with a seroconversion that never or only transiently occurred. SLE disease features, treatment received and immunological characteristics did not differ between protected and unprotected patients except for the pre-vaccination IgG2 serum levels. Serum IgG2 level >2.125 µg/ml showed a sensitivity of 100% and a specificity of 90.9% for long-term protection. Sequential pneumococcal vaccination conferred poor immune protection in SLE. Baseline IgG2 serum level identified patients able to benefit from pneumococcal vaccination.
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Affiliation(s)
- Anne-Laure Gerard
- Département de Médecine Interne, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mathilde Bahuaud
- Plateforme d'Immunomonitoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hotel Dieu, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Chrystelle Francois
- Département de Médecine Interne, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Aucouturier
- Centre de Recherche Saint-Antoine, INSERM/UMR S938, Université Pierre et Marie Curie, Paris, France
| | - Helene Moins-Teisserenc
- Laboratoire d'Hématologie, INSERM UMR-1160, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Frédéric Batteux
- Plateforme d'Immunomonitoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hotel Dieu, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; Centre de Recherche sur l'Inflammation, INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; Centre de Recherche sur l'Inflammation, INSERM U1149, Paris, France.
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19
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Whitaker JA. Immunization Strategies to Span the Spectrum of Immunocompromised Adults. Mayo Clin Proc 2020; 95:1530-1548. [PMID: 32067801 DOI: 10.1016/j.mayocp.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 01/01/2023]
Abstract
The Advisory Committee on Immunization Practices to the US Centers for Disease Control and Prevention provides annual recommendations for routine adult immunizations. Many recommendations consider patient factors such as age, medical conditions, and medications that increase an individual's risk for infection with a vaccine-preventable disease. These factors, particularly those that lead to immunocompromise, may also alter the risk-benefit ratio for live vaccines, and/or lead to decreased vaccine immunogenicity and effectiveness. The provider may need to consider alternative vaccination strategies, including higher antigen dose vaccines, adjuvanted vaccines, avoidance of live vaccines, and careful timing of vaccination to optimize safety and effectiveness in immunocompromised populations. This thematic review discusses general principles regarding immunization of adults across the spectrum of immunocompromise, examines current guidelines and studies that support them, and outlines future research needs.
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Affiliation(s)
- Jennifer A Whitaker
- Department of Molecular Virology and Department of Microbiology and Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX.
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20
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Elhusseiny KM, Abd-Elhay FAE, Kamel MG. Possible therapeutic agents for COVID-19: a comprehensive review. Expert Rev Anti Infect Ther 2020; 18:1005-1020. [PMID: 32538209 DOI: 10.1080/14787210.2020.1782742] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged in China. There are no available vaccines or antiviral drugs for COVID-19 patients. Herein, we represented possible therapeutic agents that may stand as a potential therapy against COVID-19. AREAS COVERED We searched PubMed, Google Scholar, and clinicaltrials.gov for relevant papers. We showed some agents with potentially favorable efficacy, acceptable safety as well as good pharmacokinetic profiles. Several therapies are under assessment to evaluate their efficacy and safety for COVID-19. However, some drugs were withdrawn due to their side effects after demonstrating some clinical efficacy. Indeed, the most effective therapies could be organ function support, convalescent plasma, anticoagulants, and immune as well as antiviral therapies, especially anti-influenza drugs due to the similarities between respiratory viruses regarding viral entry, uncoating, and replication. We encourage giving more attention to favipiravir, remdesivir, and measles vaccine. EXPERT OPINION A combination, at least dual or even triple therapy, of the aforementioned efficacious and safe therapies is greatly recommended for COVID-19. Further, patients should have a routine assessment for their coagulation and bleeding profiles as well as their inflammatory and cytokine concentrations.
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Affiliation(s)
- Khaled Mosaad Elhusseiny
- Faculty of Medicine, Al-Azhar University , Cairo, Egypt.,Sayed Galal University Hospital , Cairo, Egypt.,Egyptian Collaborative Research Team , Egypt
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21
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Murdaca G, Noberasco G, Battaglini A, Vassallo C, Giusti F, Greco M, Schiavi C, Sticchi L, Icardi G, Orsi A. Systemic Sclerosis and Vaccinations: A Register-Based Cohort Study about Seasonal Influenza and Streptococcus pneumoniae Vaccination Rate and Uptake from Liguria Regional Center, Northwest Italy. Vaccines (Basel) 2020; 8:vaccines8020204. [PMID: 32354027 PMCID: PMC7349884 DOI: 10.3390/vaccines8020204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022] Open
Abstract
Systemic sclerosis (SSc) is the connective tissue disease with the highest mortality and patients with chronic inflammatory immune-mediated diseases are at high risk of acquiring infections as they are often treated with immunosuppressive or biological drugs. This study, conducted among the patients followed by our clinical immunology, part of the Internal Medicine Department in the Ospedale Policlinico San Martino, Genoa, northwest Italy, has set itself the primary objective of analyzing the vaccine uptake and the vaccination coverage against both seasonal influenza and S. pneumoniae in a cohort of patients with SSc. We evaluated the influenza and pneumococcal vaccination rate among various subgroups of patients and the source of the recommendation for vaccination. We evaluated the vaccination rate changes between the two years considered in our study. We also calculated a binomial logistic regression between vaccination acceptance and clinical and demographics characteristics of the patients to evaluate the adjusted odds ratio (OR) of each factor on vaccination. The vaccination coverage that resulted was significantly higher than in other similar studies. Age over 65 years old, interstitial lung disease, and ongoing immunosuppressive therapy were significantly related with acceptance to both vaccinations using univariate analyses, but the multivariate logistic regression found a significant correlation only with the age and therapy factors.
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Affiliation(s)
- Giuseppe Murdaca
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, 16132 Genova, Italy; (C.V.); (F.G.); (M.G.); (C.S.)
- Correspondence: ; Tel.: +39-0105554676
| | - Giovanni Noberasco
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, 16132 Genova, Italy; (G.N.); (A.B.); (L.S.); (G.I.); (A.O.)
| | - Alberto Battaglini
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, 16132 Genova, Italy; (G.N.); (A.B.); (L.S.); (G.I.); (A.O.)
| | - Chiara Vassallo
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, 16132 Genova, Italy; (C.V.); (F.G.); (M.G.); (C.S.)
| | - Francesca Giusti
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, 16132 Genova, Italy; (C.V.); (F.G.); (M.G.); (C.S.)
| | - Monica Greco
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, 16132 Genova, Italy; (C.V.); (F.G.); (M.G.); (C.S.)
| | - Chiara Schiavi
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, 16132 Genova, Italy; (C.V.); (F.G.); (M.G.); (C.S.)
| | - Laura Sticchi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, 16132 Genova, Italy; (G.N.); (A.B.); (L.S.); (G.I.); (A.O.)
- Hygiene Unit, “Ospedale Policlinico San Martino IRCCS”, 16132 Genova, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, 16132 Genova, Italy; (G.N.); (A.B.); (L.S.); (G.I.); (A.O.)
- Hygiene Unit, “Ospedale Policlinico San Martino IRCCS”, 16132 Genova, Italy
| | - Andrea Orsi
- Department of Health Sciences, Vaccines and Clinical Trials Unit, University of Genova, 16132 Genova, Italy; (G.N.); (A.B.); (L.S.); (G.I.); (A.O.)
- Hygiene Unit, “Ospedale Policlinico San Martino IRCCS”, 16132 Genova, Italy
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22
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Kuang ZS, Yang YL, Wei W, Wang JL, Long XY, Li KY, Tong CY, Sun Z, Song ZJ. Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised host: A retrospective observational study. World J Emerg Med 2020; 11:145-151. [PMID: 32351646 DOI: 10.5847/wjem.j.1920-8642.2020.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) in autoimmune diseases (AID)-induced immunocompromised host (ICH) had a high incidence and poor prognosis. However, only a few studies had determined the clinical characteristics of these patients. Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH. METHODS From 2013 to 2018, a total of 94 CAP patients accompanied with AID-induced ICH, admitted to Emergency Department of Zhongshan Hospital, Fudan University, were enrolled in this study. Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations (GEEs) analysis. An open-cohort approach was used to classify patient's outcomes into the survival or non-survival group. RESULTS The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%. No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups, while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients (P<0.05). Both noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were performed more frequently in non-survival group (P< 0.05). By the multivariate GEEs analysis, the repeated measured longitudinal indices of neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]=1.055, 95% confidence interval [95%CI] 1.025-1.086), lactate dehydrogenase (LDH) (OR=1.004, 95%CI 1.002-1.006) and serum creatinine (sCr) (OR=1.018, 95%CI 1.008-1.028), were associated with a higher risk of mortality. CONCLUSION The CAP patients in AID-induced ICH had a high mortality. A significant relationship was demonstrated between the factors of NLR, LDH, sCr and mortality risk in these patients.
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Affiliation(s)
- Zhong-Shu Kuang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi-Lin Yang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Wei
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Li Wang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiang-Yu Long
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ke-Yong Li
- Department of Pharmacology, University of Virginia School of Medicine Charlottesville, Virginia, USA
| | - Chao-Yang Tong
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhan Sun
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhen-Ju Song
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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23
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Sivaraman V, Wise KA, Cotton W, Barbar-Smiley F, AlAhmed O, MacDonald D, Lemle S, Yildirim-Toruner C, Ardoin SP, Ardura MI. Previsit Planning Improves Pneumococcal Vaccination Rates in Childhood-Onset SLE. Pediatrics 2020; 145:peds.2018-3141. [PMID: 31879277 DOI: 10.1542/peds.2018-3141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (c-SLE) is a complex autoimmune disease that requires systemic immunosuppressive therapy. Infections are the second leading cause of death in these patients, with invasive pneumococcal infections being a major preventable cause of morbidity and mortality. Pneumococcal vaccination is recommended in this population; however, vaccination rates remain low. METHODS The plan-do-study-act method of quality improvement was applied. We calculated baseline vaccination rates for pneumococcal conjugate and pneumococcal polysaccharide vaccines in patients with c-SLE in the rheumatology clinic from January 2015 to August 2016. We developed an age-based algorithm to simplify the vaccination guidelines. The clinical pharmacist and nurses performed weekly previsit planning to update vaccine records, make targeted recommendations, and ensure vaccine availability. The primary outcome measure was the percentage patients with of c-SLE seen per month who had received age-appropriate pneumococcal vaccination. RESULTS The percentage of children receiving at least 1 pneumococcal vaccine increased from 24.9% to 92.7% by 12 months. By 18 months, the compliance rate with both pneumococcal vaccines increased from 2.5% to 87.3%, with sustained results. No serious adverse events or disease flares were reported. CONCLUSIONS By identifying the major barriers to pneumococcal vaccination in our population with c-SLE, we significantly improved vaccination rates while decreasing time burden on providers. We attribute our success to a team-based quality improvement approach and plan to implement alerts in the electronic health record to streamline the process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Monica I Ardura
- Infectious Diseases and Host Defense, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
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24
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Cantarelli C, Guglielmo C, Hartzell S, Salem FE, Andrighetto S, Gazivoda VP, Fiaccadori E, La Manna G, Zaza G, Leventhal J, Tassiulas I, Cravedi P. Pneumococcal Polysaccharide Vaccine Ameliorates Murine Lupus. Front Immunol 2019; 10:2695. [PMID: 31824490 PMCID: PMC6879550 DOI: 10.3389/fimmu.2019.02695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/01/2019] [Indexed: 12/04/2022] Open
Abstract
Current guidelines encourage administering pneumococcal vaccine Prevnar-13 to patients with lupus, but whether such vaccinations affect disease severity is unclear. To address this issue, we treated 3-month-old MRL-lpr mice, that spontaneously develop a lupus-like syndrome, with Prevnar-13 or vehicle control. After 3 months, we quantified circulating anti-Pneumococcal polysaccharide capsule (PPS) antibodies and signs of disease severity, including albuminuria, renal histology and skin severity score. We also compared immunophenotypes and function of T and B cells from treated and untreated animals. Prevnar-13 elicited the formation of anti-pneumococcal IgM and IgG. Prevnar-13 treated animals showed reduced albuminuria, renal histological lesions, and milder dermatitis compared to vehicle-treated controls. Mitigated disease severity was associated with reduced and increased T follicular helper cells (TFH) and T follicular regulatory cells (TFR), respectively, in Prevnar-treated animals. T cells from Prevnar-13 vaccinated mice showed differential cytokine production after aCD3/aCD28 stimulation, with significantly decreased IL-17 and IL-4, and increased IL-10 production compared to non-vaccinated mice. In conclusion, pneumococcal vaccination elicits anti-pneumococcal antibody response and ameliorates disease severity in MRL-lpr mice, which associates with fewer TFH and increased TFR. Together, the data support use of Prevnar vaccination in individuals with SLE.
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Affiliation(s)
- Chiara Cantarelli
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Chiara Guglielmo
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Susan Hartzell
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fadi El Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sofia Andrighetto
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy
| | - Victor P Gazivoda
- Department of Surgery, Maimonides Medical Center, New York, NY, United States
| | - Enrico Fiaccadori
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy
| | - Jeremy Leventhal
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ioannis Tassiulas
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Paolo Cravedi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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25
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Vaccination Recommendations for Adults With Autoimmune Inflammatory Rheumatic Diseases in Latin America. J Clin Rheumatol 2019; 24:138-147. [PMID: 29232324 DOI: 10.1097/rhu.0000000000000624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with autoimmune inflammatory rheumatic diseases (AIRDs) are at increased risk of contracting severe infections and suffering complications, particularly when they are receiving immunomodulating therapy. Vaccination is an important means to prevent many potential infections and thereby reduce the morbidity and mortality associated with AIRD. The purpose of this consensus document is to provide health care professionals with recommendations for the vaccination of AIRD patients who reside in Latin America. The recommendations were developed by an expert committee from the region based on a review of the literature and their clinical experience. METHODS The Americas Health Foundation (AHF) used PubMed and EMBASE to identify clinicians and scientists with an academic or hospital affiliation and who had published in the field of adult vaccination and rheumatic diseases since 2010. As a result of this effort, AHF convened an 8-member panel of clinical and scientific experts from Latin America. Both the AHF and panel members conducted a careful literature review to identify relevant publications in the areas of adult vaccination and rheumatology, and the sum of the articles identified was provided to the entire panel. Prior to the conference, panelists were each asked to prepare a written response to a salient issue on the subject, identified by AHF. RESULTS AND CONCLUSIONS During the conference, each response was edited by the entire group, through numerous drafts and rounds of discussion until a complete consensus on vaccination recommendations for adult patients with AIRDs was obtained, including 7 key recommendations.
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26
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Lim CC, Yoon N, Sim J, Mok I, Choo J. The elderly with renal disease undergoing kidney biopsy-an opportunity for vaccination? Clin Kidney J 2019; 13:263-264. [PMID: 32296531 PMCID: PMC7147299 DOI: 10.1093/ckj/sfz111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore,Correspondence and offprint requests to: Cynthia C. Lim; E-mail:
| | - Nicholas Yoon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jackie Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Irene Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
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27
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Murdaca G, Negrini S, Pellecchio M, Greco M, Schiavi C, Giusti F, Puppo F. Update upon the infection risk in patients receiving TNF alpha inhibitors. Expert Opin Drug Saf 2019; 18:219-229. [DOI: 10.1080/14740338.2019.1577817] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Giuseppe Murdaca
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Negrini
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Pellecchio
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Greco
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Schiavi
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Giusti
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Puppo
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
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28
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Hu L, Chen Z, Jin Y, Jiang B, Wang X, Yu H, Yang X. Incidence and predictors of aorta calcification in patients with systemic lupus erythematosus. Lupus 2019; 28:275-282. [PMID: 30739545 DOI: 10.1177/0961203319826689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective Artery calcification, as subclinical atherosclerosis, is attracting attention. The aim of this study was to determine the prevalence and risk factors of artery calcification in patients with systemic lupus erythematosus. Methods 641 patients with systemic lupus erythematosus were enrolled in the study. Demographic, clinical, and laboratory characteristics were collected. Calcification score was quantified from the multi-detector computed tomography scan image using the Agatston Score method. Results The total incidence of artery calcification was 25.9% (166/641), of which the percentages of aorta calcium and coronary artery calcification were 23.1% (148/641) and 8.4% (54/641), respectively. In multivariate models, systemic lupus erythematosus patients with artery calcification had longer disease duration than patients without artery calcification ( p < 0.05). Presence of serositis (OR 2.559, 95%CI 1.414–4.632), pneumonia (OR 2.022, 95%CI 1.102–3.711) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (OR 1.049, 95%CI 1.004–1.095) were independently associated with increased risk of aorta calcium, while the duration of corticosteroids use (OR 1.039, 95%CI 1.002–1.078) and cyclophosphamide therapy (OR 8.251, 95%CI 2.496–27.279) were independently associated with increased risk of coronary artery calcification in systemic lupus erythematosus patients. In systemic lupus erythematosus patients, aorta calcium was prone to occur at a younger age compared to coronary artery calcification, and aorta calcium score was positively correlated with age. Conclusions Systemic lupus erythematosus patients had a much earlier onset and higher incidences of aorta calcium than coronary artery calcification. Presence of serositis, pneumonia, and higher SLEDAI score may predict increased risk of aorta calcium.
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Affiliation(s)
- L Hu
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Z Chen
- Center of Clinical Epidemiology & Biostatistics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Y Jin
- Department of Radiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - B Jiang
- Department of Radiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - X Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - H Yu
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, P.R. China
| | - X Yang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
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29
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Adawi M, Bragazzi NL, McGonagle D, Watad S, Mahroum N, Damiani G, Conic R, Bridgewood C, Mahagna H, Giacomelli L, Eggenhöffner R, Mahamid M, Pigatto PDM, Amital H, Watad A. Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis. Autoimmun Rev 2018; 18:73-92. [PMID: 30408581 DOI: 10.1016/j.autrev.2018.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
The immunological perturbations associated with systemic lupus erythematosus (SLE) put many patients at a higher risk of infections, including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed upon. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short-term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long-term findings, with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies, which have been included in the present systematic review and meta-analysis. All studies were designed as longitudinal investigations, 2, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Total sample size included 601 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36% to 97.6%. According to our systematic review and metanalysis, high erythrocyte sedimentation rate (ESR), older age, earlier SLE onset, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to one third of cases reporting mild/low-grade complaints. In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness, according to our systematic review and meta-analysis, in such patients, preventive strategies mainly by immunization, are required in all age groups and, in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment. PROSPERO registration code CRD42018103605.
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Affiliation(s)
- Mohammad Adawi
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Padeh and Ziv Medical Centers, Zefat, Israel
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Samaa Watad
- Department of Statistics and Operations Research, Tel Aviiv University, Tel Aviv, Israel
| | - Naim Mahroum
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), GISED, Bergamo, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy; Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, 20126 Milan, Italy
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Hussein Mahagna
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Luca Giacomelli
- Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy
| | - Roberto Eggenhöffner
- Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy
| | - Mahmud Mahamid
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Endoscopy Unit of the Nazareth Hospital EMMS, Nazareth, Israel
| | - Paolo Daniele Maria Pigatto
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Abdulla Watad
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
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Recommendations and barriers to vaccination in systemic lupus erythematosus. Autoimmun Rev 2018; 17:990-1001. [PMID: 30103044 DOI: 10.1016/j.autrev.2018.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/06/2023]
Abstract
Patients with Systemic Lupus Erythematosus (SLE) pose a unique dilemma pertaining to immunization against common pathogens. SLE patients are usually not immunized with vaccines based on the fear of either precipitating infection in this immunosuppressed patient population (with live vaccines) or aggravating autoimmunity and hence lupus flares (with any vaccines). However, elevated vulnerability to infection makes patients with SLE precisely the population that needs protection from vaccine-preventable diseases. A summary of guidelines from the Centers for Disease Control and Prevention, professional societies, review articles and expert opinions regarding use of individual vaccines applicable to adults with SLE is presented in this review.
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Pneumococcal infection in patients with systemic lupus erythematosus. Joint Bone Spine 2018; 85:333-336. [DOI: 10.1016/j.jbspin.2017.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/08/2017] [Indexed: 12/21/2022]
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Zhu Z, Yang C, Wen L, Liu L, Zuo X, Zhou F, Gao J, Zheng X, Shi Y, Zhu C, Liang B, Yin X, Wang W, Cheng H, Shen S, Tang X, Tang H, Sun L, Zhang A, Yang S, Cui Y, Zhang X, Sheng Y. RETRACTED: Bach2 regulates aberrant activation of B cell in systemic lupus erythematosus and can be negatively regulated by BCR-ABL/PI3K. Exp Cell Res 2018; 365:138-144. [PMID: 29501569 DOI: 10.1016/j.yexcr.2018.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 01/20/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The article has been retracted at the request of the Editor-in-Chief and the authors. The journal is retracting this paper after the authors reached out to the journal with a statement that several images contained duplications from another published paper. Part of the panels in Figure 1D and Figure 4D are duplications of panels in Figure 7 of Wang et al., Int J Mol Sci (2016), DOI: 10.3390/ijms17060969. The β-actin panel in Figure 2E is same as the α-tubulin panel in Figure 4B. In addition, the corresponding author informed the journal that “there were serious conflicts of personal interest, part of co-authors of this paper were not involved in the study and not aware of the submission, and they did not authorize their names to appear in the article”.
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Affiliation(s)
- Zhengwei Zhu
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Chao Yang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Leilei Wen
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Lu Liu
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Xianbo Zuo
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Fusheng Zhou
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Jinping Gao
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Xiaodong Zheng
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Yinjuan Shi
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Caihong Zhu
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Bo Liang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Xianyong Yin
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Wenjun Wang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Hui Cheng
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Songke Shen
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Xianfa Tang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Huayang Tang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Liangdan Sun
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Anping Zhang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Sen Yang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, East Street Cherry Park, Chaoyang District, Beijing 100029, China
| | - Xuejun Zhang
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China
| | - Yujun Sheng
- Institute of Dermatology and Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui 230032, China.
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Chatham W, Chadha A, Fettiplace J, Kleoudis C, Bass D, Roth D, Gordon D. A randomized, open-label study to investigate the effect of belimumab on pneumococcal vaccination in patients with active, autoantibody-positive systemic lupus erythematosus. Lupus 2017; 26:1483-1490. [PMID: 28467293 PMCID: PMC5673008 DOI: 10.1177/0961203317703495] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/14/2017] [Indexed: 01/06/2023]
Abstract
Objective Intravenous belimumab 10 mg/kg is approved as an add-on therapy in patients with active, autoantibody-positive systemic lupus erythematosus. This study aimed to assess the impact of belimumab on immune response to pneumococcal vaccination in patients with systemic lupus erythematosus. Methods This was a Phase 4, open-label study (GSK BEL115470; NCT01597492) conducted in the United States. Patients were randomized (7:9) to receive a 23-valent pneumococcal vaccination four weeks prior to (pre-belimumab cohort) or 24 weeks after (belimumab-concurrent cohort) commencing four-weekly belimumab 10 mg/kg intravenous treatment plus standard systemic lupus erythematosus therapy. Analyses of vaccine titers were performed on the as-treated population (received ≥1 dose of belimumab). The primary endpoint was the proportion of patients with positive antibody responses (≥2-fold increase from pre-vaccination levels, or post-vaccination level ≥ 0.6 µg/mL if pre-vaccination levels were unquantifiable) to ≥1 of 23 pneumococcal vaccine serotypes, four weeks post vaccination. Other endpoints included the proportion of patients with positive antibody responses to ≥2 to ≥10, and ≥11-23 (post hoc analysis) of serotypes. Safety was assessed by monitoring adverse events. Results Seventy-nine patients received pneumococcal vaccination (pre-belimumab cohort, n = 34; belimumab-concurrent cohort, n = 45). The majority (87.3% [69/79]) completed the study; 10 (12.7%) withdrew (patient request, n = 3; adverse event, n = 3; lost to follow-up, n = 2; other, n = 2). At Week 4 post-vaccination, 97.0% (32/33) and 97.6% (40/41) of patients (pre-belimumab and concurrent belimumab cohorts, respectively) had a positive response to ≥1 of 23 pneumococcal serotypes. Over 85% of patients in both cohorts responded to ≥10 of serotypes, approximately 80% responded to ≥12 serotypes, and approximately two-thirds responded to ≥16 serotypes. Little difference was observed between cohorts across a broad response, up to 23 serotypes. Eight (23.5%) patients experienced an adverse event considered by the investigator to be treatment-related in the pre-belimumab cohort and four (8.9%) in the belimumab-concurrent cohort; seven patients experienced non-fatal serious adverse events (pre-belimumab cohort, 11.8% [ n = 4]; concurrent-belimumab cohort, 6.7% [ n = 3]), and no deaths were reported. Conclusion The proportion of patients generating a response to ≥1 pneumococcal serotype did not differ between the pre-belimumab and belimumab-concurrent cohorts; the proportions were also comparable across a broader response (from ≥2 serotypes to 23 serotypes).
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Affiliation(s)
- W Chatham
- University of Alabama at Birmingham, Birmingham, USA
| | - A Chadha
- Austin Regional Clinic, Austin, USA
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Serre J, François C, der Haegen MCV, Papo T, Goulenok T, Sacre K. Nurse-led vaccination program dramatically improves pneumococcal vaccination coverage among patients with autoimmune inflammatory disorders. Eur J Intern Med 2017; 43:e43-e45. [PMID: 28552464 DOI: 10.1016/j.ejim.2017.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Justine Serre
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Chrystel François
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie Claude Van der Haegen
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France.
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Murdaca G, Negrini S, Magnani O, Penza E, Pellecchio M, Gulli R, Mandich P, Puppo F. Update upon efficacy and safety of etanercept for the treatment of spondyloarthritis and juvenile idiopathic arthritis. Mod Rheumatol 2017; 28:417-431. [DOI: 10.1080/14397595.2017.1366006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Giuseppe Murdaca
- Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Simone Negrini
- Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Ottavia Magnani
- Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Elena Penza
- Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Marco Pellecchio
- Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Rossella Gulli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Section of Medical Genetics, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Section of Medical Genetics, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Francesco Puppo
- Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino, Genova, Italy
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Grabar S, Groh M, Bahuaud M, Le Guern V, Costedoat-Chalumeau N, Mathian A, Hanslik T, Guillevin L, Batteux F, Launay O. Pneumococcal vaccination in patients with systemic lupus erythematosus: A multicenter placebo-controlled randomized double-blind study. Vaccine 2017; 35:4877-4885. [PMID: 28784280 DOI: 10.1016/j.vaccine.2017.07.094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Invasive pneumococcal disease and respiratory tract infections are both frequent and severe in patients with systemic lupus erythematosus (SLE). This study aimed to compare the immunological efficacy and safety of pneumococcal vaccination with the 23-valent polysaccharide (PPS) vaccine alone to a sequential immunization with the 7-valent pneumococcal conjugate (PnCj) vaccine followed by PPS in patients with SLE and stable diseaase. METHODS Multicenter randomized placebo-controlled double-blind trial: PPS vaccine alone (placebo-PPS group) or PnCj vaccine followed by PPS vaccine (PnCj-PPS group) 24weeks later. The primary endpoint was the rate of responders at week 28 to at least 5 of the 7 serotypes (4, 6B, 9V, 14, 18C, 19F and 23F) shared by both PPS and PnCj. Pneumococcal IgG antibodies' opsonophagocytic activity (OPA) were also assessed. RESULTS Twenty-five patients in the placebo-PPS group and 17 in the PnCj-PPS group were included in a modified intention-to-treat analysis. The primary endpoint was reached in 72% (18/25) in the placebo-PPS and 76% (13/17) in the PnCj-PPS group (p=0.75). There was no difference in the rates of responders with OPA. At week 52, 13/18 (72%) patients in the placebo-PPS group and 10/13 (77%) patients in the PnCj-PPS group (p=0.77) that met the primary endpoint at week 28 were still responders to ≥5/7 serotypes shared by both PPS and PnCj vaccines. Nine SLE flares were reported in 6 patients (4 in the placebo-PPS and 2 in the PnCj-PPS groups respectively, p=0.70). CONCLUSION Sequential administration of PnCj vaccine followed by PPS vaccine is safe and shows short-term immunological efficacy in patients with SLE but was not superior to the PPS vaccine alone. TRIAL REGISTRATION www.clinicaltrials.gov, NCT NCT00611663.
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Affiliation(s)
- Sophie Grabar
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Unité de Biostatistique et Epidémiologie, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Paris, France; INSERM, UPMC Université Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - Matthieu Groh
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Mathilde Bahuaud
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Département d'Immunologie Biologique, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Paris, France
| | - Véronique Le Guern
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Nathalie Costedoat-Chalumeau
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Alexis Mathian
- Université Pierre et Marie Curie, Sorbonne Paris Cité AP-HP, Service de Médecine Interne 2, Centre de Référence National pour le Lupus et le Syndrome des Antiphospholipides, institut E3M, Paris, France
| | - Thomas Hanslik
- Université Versailles Saint-Quentin-en-Yvelines, APHP, Service de Médecine Interne, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Loïc Guillevin
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Frédéric Batteux
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Département d'Immunologie Biologique, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Paris, France
| | - Odile Launay
- Inserm, CIC 1417, Paris, France; Université Paris Descartes, Sorbonne Paris Cité AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Fédération d'Infectiologie, Paris, France; Inserm, F-CRIN I-REIVAC, France.
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Bragazzi NL, Watad A, Sharif K, Adawi M, Aljadeff G, Amital H, Shoenfeld Y. Advances in our understanding of immunization and vaccines for patients with systemic lupus erythematosus. Expert Rev Clin Immunol 2017; 13:939-949. [DOI: 10.1080/1744666x.2017.1361321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kassem Sharif
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mohammad Adawi
- Faculty of Medicine, Baruch Padeh Medical Center, Bar-Ilan University, Israel
| | - Gali Aljadeff
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Howard Amital
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Watad A, Quaresma M, Brown S, Cohen Tervaert JW, Rodríguez-Pint I, Cervera R, Perricone C, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld’s syndrome) – An update. Lupus 2017; 26:675-681. [DOI: 10.1177/0961203316686406] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) has been widely described in many studies conducted thus far. The syndrome incorporates five immune-mediated conditions, all associated with previous exposure to various agents such as vaccines, silicone implants and several others. The emergence of ASIA syndrome is associated with individual genetic predisposition, for instance those carrying HLA-DRB1*01 or HLA-DRB4 and results from exposure to external or endogenous factors triggering autoimmunity. Such factors have been demonstrated as able to induce autoimmunity in both animal models and humans via a variety of proposed mechanisms. In recent years, physicians have become more aware of the existence of ASIA syndrome and the relationship between adjuvants exposure and autoimmunity and more cases are being reported. Accordingly, we have created a registry that includes at present more than 300 ASIA syndrome cases that have been reported by different physicians worldwide, describing various autoimmune conditions induced by diverse adjuvants. In this review, we have summarized the updated literature on ASIA syndrome and the knowledge accumulated since 2013 in order to elucidate the association between the exposure to various adjuvant agents and its possible clinical manifestations. Furthermore, we especially referred to the relationship between ASIA syndrome and systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).
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Affiliation(s)
- A Watad
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
| | - M Quaresma
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
| | - S Brown
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Spain
| | - C Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialita Mediche, Sapienza Universita di Roma, Italy
| | - Y Shoenfeld
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
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Vaccinations and risk of systemic lupus erythematosus and rheumatoid arthritis: A systematic review and meta-analysis. Autoimmun Rev 2017; 16:756-765. [PMID: 28483543 DOI: 10.1016/j.autrev.2017.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the past several years, more and more studies proposed some concerns on the possibly increased risk of autoimmune diseases in individuals receiving vaccinations, but published studies on the associations of vaccinations with risks of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) reported conflicting findings. A systematic review and meta-analysis was carried out to comprehensively evaluate the relationship between vaccinations and risk of SLE and RA. METHODS Pubmed, Web of Science and Embase were searched for observational studies assessing the associations of vaccinations with risks of RA and SLE. Two authors independently extracted data from those eligible studies. The quality of eligible studies was assessed by using the Newcastle-Ottawa Scale (NOS). The pooled relative risk (RR) with 95% confidence intervals (CIs) was used to measure the risk of RA and SLE associated with vaccinations, and was calculated through random-effect meta-analysis. RESULTS Sixteen observational studies were finally considered eligible, including 12 studies on the association between vaccinations and SLE risk and 13 studies on the association between vaccinations and RA risk. The pooled findings suggested that vaccinations significantly increased risk of SLE (RR=1.50; 95%CI 1.05-2.12, P=0.02). In addition, there was an obvious association between vaccinations and increased risk of RA (RR=1.32; 95%CI 1.09-1.60, P=0.004). Meta-analysis of studies reporting outcomes of short vaccinated time also suggested that vaccinations could significantly increase risk of SLE (RR=1.93; 95%CI 1.07-3.48, P=0.028) and RA (RR=1.48; 95%CI 1.08-2.03, P=0.015). Sensitivity analyses in studies with low risk of bias also found obvious associations of vaccinations with increased risk of RA and SLE. CONCLUSION This study suggests that vaccinations are related to increased risks of SLE and RA. More and larger observational studies are needed to further verify the findings above and to assess the associations of vaccinations with other rheumatic diseases.
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Lim CC, Liu PY, Tan HZ, Lee P, Chin YM, Mok IYJ, Chan CM, Choo JCJ. Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study. Nephrology (Carlton) 2017; 22:478-484. [DOI: 10.1111/nep.12809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/29/2016] [Accepted: 05/03/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Pei Yun Liu
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Peishan Lee
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Irene YJ Mok
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Choong Meng Chan
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Jason CJ Choo
- Department of Renal Medicine; Singapore General Hospital; Singapore
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International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus. Autoimmun Rev 2017; 16:650-657. [PMID: 28434948 DOI: 10.1016/j.autrev.2017.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/PURPOSE Despite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE. METHODS The recommendations were developed by a formal consensus method. This method aims to formalize the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations. RESULTS A total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation. CONCLUSION Overall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience.
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Wakefield D, McCluskey P, Wildner G, Thurau S, Carr G, Chee SP, Forrester J, Dick A, Hudson B, Lightman S, Smith J, Tugal-Tutkun I. Inflammatory eye disease: Pre-treatment assessment of patients prior to commencing immunosuppressive and biologic therapy: Recommendations from an expert committee. Autoimmun Rev 2017; 16:213-222. [PMID: 28137477 DOI: 10.1016/j.autrev.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022]
Abstract
AIM To outline recommendations from an expert committee on the assessment and investigation of patients with severe inflammatory eye disease commencing immunosuppressive and/or biologic therapy. METHOD The approach to assessment is based on the clinical experience of an expert committee and a review of the literature with regard to corticosteroids, immunosuppressive drug and biologic therapy and other adjunct therapy in the management of patients with severe sight-threatening inflammatory eye disease. CONCLUSION We recommend a careful assessment and consultative approach by ophthalmologists or physicians experienced in the use of immunosuppressive agents for all patients commencing immunosuppressive and/or biologic therapy for sight threatening inflammatory eye disease with the aim of preventing infection, cardiovascular, metabolic and bone disease and reducing iatrogenic side effects.
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Affiliation(s)
- Denis Wakefield
- University of New South Wales, Faculty of Medicine, Kensington, Australia.
| | - Peter McCluskey
- Save Sight Institute, Sydney Eye Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gerhild Wildner
- Section of Immunobiology, Department of Ophthalmology, Clinic of the University of Munich, Munich, Germany
| | - Stephan Thurau
- Section of Immunobiology, Department of Ophthalmology, Clinic of the University of Munich, Munich, Germany
| | - Gregory Carr
- Manly Hospital, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Department of Ophthalmology, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore National Eye Centre, Ocular Inflammation and Immunology Department, Singapore
| | - John Forrester
- The Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Andrew Dick
- UCL-Institute of Ophthalmology, London, UK; School of Clinical Science, University of Bristol, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - Bernard Hudson
- Department of Microbiology & Infectious Diseases, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia
| | - Susan Lightman
- UCL/Institute of Ophthalmology, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Justine Smith
- Eye & Vision Health, Flinders University School of Medicine, Adelaide, Australia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Chang CC, Chang YS, Chen WS, Chen YH, Chen JH. Effects of annual influenza vaccination on morbidity and mortality in patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study. Sci Rep 2016; 6:37817. [PMID: 27910867 PMCID: PMC5133584 DOI: 10.1038/srep37817] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 10/31/2016] [Indexed: 12/18/2022] Open
Abstract
Studies on the clinical efficacy of influenza vaccination on patients with systemic lupus erythematosus (SLE) are scant. The present study compared the incidence of hospitalization, morbidity, and mortality in patients with SLE between cohorts with and without influenza vaccination. We used the Taiwan's insurance claims data between 2001 and 2012 for identifying annual adult patients with SLE with (N = 1765) and without (N = 8360) influenza vaccination. The incidence rate ratio and hazard ratio (HR) for morbidities and mortality were measured for the vaccine and nonvaccine cohorts. The vaccine cohort had a lower hospitalization rate than did the nonvaccine cohort, with an adjusted HR of 0.82 (95% CI 0.73-0.92). Furthermore, the vaccine cohort was less likely to be admitted to the intensive care unit [adjusted HR 0.55 (95% CI 0.39-0.79)], to be hospitalized for septicemia, bacteremia, or viremia [adjusted HR 0.48 (95% CI 0.32-0.73)], to undergo in-hospital dialysis [adjusted HR 0.40 (95% CI 0.20-0.81)], and were less predisposed to death [adjusted HR 0.41 (95% CI 0.27-0.61)]. In conclusion, influenza vaccination in patients with SLE is associated with a reduced risk of morbidity and mortality.
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Affiliation(s)
- Chi-Ching Chang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hsuan Chen
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Jin-Hua Chen
- Biostatistics Center and School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
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Jeltsch-David H, Muller S. Autoimmunity, neuroinflammation, pathogen load: A decisive crosstalk in neuropsychiatric SLE. J Autoimmun 2016; 74:13-26. [DOI: 10.1016/j.jaut.2016.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 12/23/2022]
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Abstract
Our PubMed search for peer-reviewed articles published in the 2014 solar year retrieved a significantly higher number of hits compared to 2013 with a net 28 % increase. Importantly, full articles related to autoimmunity constitute approximately 5 % of immunology articles. We confirm that our understanding of autoimmunity is becoming a translational paradigm with pathogenetic elements rapidly followed by new treatment options. Furthermore, numerous clinical and pathogenetic elements and features are shared among autoimmune diseases, and this is well illustrated in the recent literature. More specifically, the past year witnessed critical revisions of our understanding and management of antiphospholipid syndrome with new exciting data on the pathogenicity of the serum anti-beta2 glycoprotein autoantibody, a better understanding of the current and new treatments for rheumatoid arthritis, and new position papers on important clinical questions such as vaccinations in patients with autoimmune disease, comorbidities, or new classification criteria. Furthermore, data confirming the important connections between innate immunity and autoimmunity via toll-like receptors or the critical role of T regulatory cells in tolerance breakdown and autoimmunity perpetuation were also reported. Lastly, genetic and epigenetic data were provided to confirm that the mosaic of autoimmunity warrants a susceptible individual background which may be geographically determined and contribute to the geoepidemiology of diseases. The 2014 literature in the autoimmunity world should be cumulatively regarded as part of an annus mirabilis in which, on a different level, the 2014 Annual Meeting of the American College of Rheumatology in Boston was attended by over 16,000 participants with over selected 3000 abstracts.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, via A. Manzoni 56, 20089 Rozzano, Milan, Italy. .,BIOMETRA Department, University of Milan, Milan, Italy.
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Mina R, Harris JG, Klein-Gitelman MS, Appenzeller S, Centeville M, Eskra D, Huggins JL, Johnson AL, Khubchandani R, Khandekar P, Lee J, Liu HM, Pendl JD, Silva CA, Silva MF, Zaal AI, DeWitt EM, Ardoin SP, Brunner HI. Initial Benchmarking of the Quality of Medical Care in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016. [PMID: 26219749 DOI: 10.1002/acr.22666] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the quality of medical care in childhood-onset systemic lupus erythematosus (SLE) at tertiary pediatric rheumatology centers as measured by observance of SLE quality indicators (SLE-QIs). METHODS International consensus has been achieved for childhood-onset SLE-QIs capturing medical care provision in 9 domains: diagnostic testing, education of cardiovascular (CV) risk and lifestyles, lupus nephritis (LN), medication management, bone health, ophthalmologic surveillance, transition, pregnancy, and vaccination. Using medical record information, the level of performance of these childhood-onset SLE-QIs was assessed in childhood-onset SLE populations treated at 4 tertiary pediatric rheumatology centers in the US, 2 in Brazil, and 1 center in India. RESULTS A total of 483 childhood-onset SLE patients were assessed. Care for the 310 US patients differed markedly for childhood-onset SLE-QIs addressing LN, bone health, vaccinations, education on CV risk, and transition planning. Performance of safety blood testing for medications was high at all centers. Despite often similar performance on the childhood-onset SLE-QI, access to kidney biopsies was lower in Brazil than in the US. Irrespective of the country of practice, larger centers tended to meet the childhood-onset SLE-QIs more often than smaller centers. CONCLUSION The childhood-onset SLE-QIs, evidence-based minimum standards of medical care, are not consistently met in the US or some other countries outside the US. This has the potential to contribute to suboptimal childhood-onset SLE outcomes.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Julia G Harris
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | | | | | - Diane Eskra
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Jiha Lee
- University of Cincinnati, Cincinnati, Ohio
| | - Hai Mei Liu
- Children's Hospital of Fudan University, Shanghai, China
| | - Joshua D Pendl
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Ahmad I Zaal
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Stacy P Ardoin
- Nationwide Children's Hospital and Ohio State University, Columbus, Ohio
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Pugès M, Biscay P, Barnetche T, Truchetet MÉ, Richez C, Seneschal J, Gensous N, Lazaro E, Duffau P. Immunogenicity and impact on disease activity of influenza and pneumococcal vaccines in systemic lupus erythematosus: a systematic literature review and meta-analysis. Rheumatology (Oxford) 2016; 55:1664-72. [PMID: 27160278 DOI: 10.1093/rheumatology/kew211] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim was to assess the immunogenicity and the impact on disease activity of pneumococcal and influenza vaccines in SLE patients. METHODS We conducted a systematic literature review and meta-analysis of studies comparing the humoral response of either pneumococcal (serotype 23F) or influenza (AH1N1, AH3N2 and B strains) vaccines between SLE patients and healthy controls, assessed by a seroconversion or a seroprotection rate 3-6 weeks after vaccination. The impact on disease activity was assessed by the comparison of the SLEDAI score before and 3-8 weeks after vaccination. Odds ratios (ORs), risk ratios and their 95% CIs were pooled using the generic inverse variance method. RESULTS Twenty studies were included, three for pneumococcal vaccine and 17 for influenza vaccine, gathering 1665 SLE patients and 826 healthy controls. For pneumococcal vaccination, no significant difference was observed, either for seroconversion rate between SLE patients and controls or for the SLEDAI score. For influenza vaccination, the response against AH1N1 was significantly reduced in SLE patients, with a lower rate of seroconversion (OR = 0.38; 95% CI: 0.27, 0.54; P < 0.00001, I(2) = 39%) and seroprotection (OR = 0.36; 95% CI: 0.28, 0.47; P < 0.00001, I(2) = 25%). For AH3N2, only seroprotection rate was significantly lower in SLE patients (OR = 0.26; 95% CI: 0.14, 0.50; P < 0.0001, I(2) = 21%). For B strain, neither seroconversion nor seroprotection rates were significantly different. Influenza vaccine did not modify the SLEDAI score. CONCLUSION The immunogenicity of influenza vaccine in SLE patients depends on the viral strains. A reduced immunogenicity against influenza A is noted, while the immunogenicity against the B strain is preserved. The pneumococcal vaccine against 23F serotype has a preserved immunogenicity. These vaccines have no impact on the SLEDAI score.
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Affiliation(s)
| | - Pascal Biscay
- Internal Medicine and Clinical Immunology, Saint-André Hospital
| | | | | | | | | | - Noémie Gensous
- Internal Medicine and Clinical Immunology, Saint-André Hospital
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - Pierre Duffau
- Internal Medicine and Clinical Immunology, Saint-André Hospital
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Jin H, Zhang G, Zhou Y, Chang C, Lu Q. Old lines tell new tales: Blaschko linear lupus erythematosis. Autoimmun Rev 2016; 15:291-306. [DOI: 10.1016/j.autrev.2015.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/26/2015] [Indexed: 12/11/2022]
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Grein IHR, Groot N, Lacerda MI, Wulffraat N, Pileggi G. HPV infection and vaccination in Systemic Lupus Erythematosus patients: what we really should know. Pediatr Rheumatol Online J 2016; 14:12. [PMID: 26956735 PMCID: PMC4782298 DOI: 10.1186/s12969-016-0072-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/25/2016] [Indexed: 12/30/2022] Open
Abstract
Patients with Systemic Lupus Erythematosus (SLE) are at increased risk for infections. Vaccination is a powerful tool to prevent infections, even in immunocompromised patients. Most non-live vaccines are immunogenic and safe in patients with SLE, even if antibody titres are frequently lower than those of healthy controls. Human papillomavirus (HPV) infections are more prevalent in SLE patients when compared to the healthy population. Low-risk types of this virus cause anogenital warts, while high risk types are strongly related to pre-malignant cervical abnormalities and cervical cancer. HPV vaccines have been developed to prevent these conditions. Although little is known about HPV vaccination in SLE, few studies in patients with autoimmune rheumatic diseases (AIRDs) have shown that HPV vaccines are safe, and capable to induce an immunogenic response in this group of patients. To date, available data suggest that HPV vaccines can be given safely to SLE patients. Given the increased incidence of cervical abnormalities due to HPV in SLE patients, this vaccination should be encouraged.
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Affiliation(s)
- Ingrid Herta Rotstein Grein
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO BOX 85090, 3508 AB, Utrecht, The Netherlands.
- Department of Pediatric Rheumatology, Pequeno Príncipe Hospital, Curitiba, Brazil.
| | - Noortje Groot
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO BOX 85090, 3508 AB, Utrecht, The Netherlands.
- Department of Pediatric Immunology, Sophia Children's Hospital - Erasmus MC, Rotterdam, The Netherlands.
| | | | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO BOX 85090, 3508 AB, Utrecht, The Netherlands.
| | - Gecilmara Pileggi
- Department of Pediatric, Division of Immunology and Rheumatology, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil.
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50
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Murdaca G, Orsi A, Spanò F, Faccio V, Puppo F, Durando P, Icardi G, Ansaldi F. Vaccine-preventable infections in Systemic Lupus Erythematosus. Hum Vaccin Immunother 2016; 12:632-43. [PMID: 26750996 PMCID: PMC4964666 DOI: 10.1080/21645515.2015.1107685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/29/2015] [Accepted: 10/09/2015] [Indexed: 12/26/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is characterized by abnormal autoantibody production and clearance. Infections are among the most important causes of morbidity and mortality in SLE patients; they have an increased frequency of severe bacterial and viral infections possibly due to inherited genetic and immunologic defects and to immunosuppressive therapies. In addition, infectious agents can switch on lupus disease expression and activity. Among the strategies to reduce the risk of infection, vaccination can be considered the most reliable option. Most vaccines are effective and safe in SLE patients, although in certain cases immunogenicity may be sub-optimal and vaccination can trigger a flare. Although these issues are currently unresolved, the risk benefit balance is in favor for vaccination to reduce the risk of infection in SLE patients. In the present review we discuss the preventive strategies currently recommended to reduce bacterial and viral infections in SLE.
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Affiliation(s)
- Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, Genoa, Italy and Clinical Immunology Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesca Spanò
- Department of Internal Medicine, University of Genoa, Genoa, Italy and Clinical Immunology Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Valeria Faccio
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy and Clinical Immunology Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
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