Impact of rituximab therapy on response to tetanus toxoid vaccination in kidney-transplant patients
Laboratoire d'Immunologie, CHU de Toulouse, Hopital Rangueil, France.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
Rituximab is used after kidney transplant to prevention or treat kidney-allograft rejection. However, the impact of rituximab on the ability of patients to respond to tetanus toxoid vaccination has not yet been studied.
The response to tetanus toxoid vaccination was analyzed in 39 kidney transplant recipients immunosuppressed by corticoids, antiproliferative agents, and/or calcineurin inhibitors. Thirteen patients had previously received rituximab (group 1), 26 patients had not (group 2). Response to control bacterial antigens and immunologic parameters (lymphocyte count, B-cell subsets, serum immunoglobulin level) were analyzed before and at 1 month after vaccination. Thirty healthy blood donors were used as controls for the before-vaccination immunologic parameters.
Before vaccination, neither patient group differed from controls in serum levels of immunoglobulins and antibodies against bacterial antigens, but they did display lower levels of CD4 T cells and B cells compared with controls. Responders to the tetanus toxoid vaccination were slightly fewer in group 1 (4/13) than in group 2 (16/26), but the intensity of the anti-tetanus toxoid response was not significantly different between these 2 groups. None of the parameters studied at the time of vaccination (anti-tetanus toxoid level, peripheral B or CD4 T-cell count, memory B-cell subsets, treatment with rituximab, time since transplant) were associated with an ability to respond to vaccination. The ability to respond to vaccination and graft outcomes were not correlated in each patient group.
Rituximab impaired the secondary immune response after tetanus toxoid vaccination, but did not abolish it in all patients.
Available from: PubMed Central
- "Patients who received cyclophosphamide or rituximab within 6 months of study entry were excluded from our study, as these medications were found to cause an impaired immune response to other vaccinations in SLE patients [31,32]. Our experience, in which the one patient who received rituximab during the vaccine protocol did not develop immunogenicity to HPV, agrees with previous experience of impaired immune response to vaccinations in patients on rituximab and cyclophosphamide. "
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ABSTRACT: Women with SLE have higher rates of persistent human papilloma virus (HPV) infections and precancerous lesions than healthy women. HPV vaccine is safe and effective in healthy females aged 9--26 years. There are limited data on the safety and immunogenicity of HPV vaccine in females with SLE, and none in adolescents with SLE. Our study evaluates the safety and immunogenicity of recombinant quadrivalent HPV vaccine, Gardasil, in adolescents and young women with SLE.
This is a prospective, open-label study. Exclusion criteria included disease exacerbation within past 30 days; rituximab or cyclophosphamide within 6 months; pregnancy. Vaccine was administered at months 0, 2, and 6. Physical examination, SLEDAI scores and laboratory studies were performed at months 0, 2, 4, 6 and 7. Each patient's SLEDAI scores and laboratory profile in the year prior to vaccine administration were used as controls for that patient. Primary outcome measures were change in SLEDAI and mean HPV antibody titers.
27 patients, 12 to 26 years, were enrolled; 20 completed the study. Nine had mild/moderate lupus flares. Mean SLEDAI scores decreased from 6.14 pre-vaccination to 4.49 post-vaccination (p = 0.01). Of 12 patients with lupus nephritis, two experienced worsening renal function during/after the study and progressed to renal failure within 18 months of the study. Both had Class IV lupus nephritis with high chronicity scores (>= 8) on renal biopsies performed within one year prior to study entry. Seropositivity post-vaccine was >94% for HPV 6, 11, 16 and 18.
Quadrivalent HPV vaccine seems generally safe and well tolerated in this series of adolescents and young women with SLE, with no increase in mean SLEDAI scores. Progression to renal failure in two patients was most likely secondary to pre-existing severe renal chronicity and not secondary to HPV vaccination. Immunogenicity to the quadrivalent HPV vaccine was excellent, with the seropositivity rate >94% in all four HPV types.
Pediatric Rheumatology 08/2013; 11(1):29. DOI:10.1186/1546-0096-11-29 · 1.61 Impact Factor
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ABSTRACT: Die Einführung der biologischen krankheitsmodifizierenden Therapeutika (DMARDs) hat die Therapieoptionen für die rheumatoide
Arthritis deutlich verbessert. Zu den häufigsten Nebenwirkungen der biologischen DMARDs gehören Infektionskomplikationen,
inklusive schwere Infektionen sowie auch selten opportunistische Infektionen. Die Betreuung von Patienten unter einer biologischen
DMARD-Therapie gehört somit mit zu den größten Herausforderungen in der rheumatologischen Praxis. Wir beschreiben hier den
gegenwärtigen Wissensstand zu Häufigkeit und Art von Infektionskomplikationen unter biologischen DMARDs. Es wird ein besonderer
Schwerpunkt auf das Risikomanagement von Problempatienten, insbesondere auf die Diagnostik und Rezidivprophylaxe der latenten
Tuberkulose und Prävention der Reaktivierung der Hepatitis-B-Virus-Infektion gelegt. Weiterhin diskutieren wir den Stellenwert
von Indikationsimpfungen in der Primärprophylaxe bei Patienten mit rheumatoider Arthritis.
The introduction of biological disease-modifying drugs (DMARDs) has substantially improved the treatment options for patients
with rheumatoid arthritis. However, infectious complications represent the most common side effects of these drugs, including
severe infections as well as rare opportunistic infections. Treating patients on biological DMARDs is therefore one of the
biggest challenges in rheumatology care. The present review describes the current state of knowledge regarding frequency and
type of infectious complications associated with biological DMARDs. The article focuses mainly on risk management, in particular
on diagnosis and recurrence prevention of tuberculosis and reactivation of hepatitis B virus infection. Furthermore, we discuss
the importance of vaccinations in primary disease prevention in patients with rheumatoid arthritis.
KeywordsRheumatoid arthritis-Immunosuppression-Risk of infection-Tuberculosis-Hepatitis B virus infection-Vaccination
Zeitschrift für Rheumatologie 12/2010; 69(10):879-888. DOI:10.1007/s00393-010-0677-2 · 0.61 Impact Factor
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ABSTRACT: The introduction of biological disease-modifying drugs (DMARDs) has substantially improved the treatment options for patients with rheumatoid arthritis. However, infectious complications represent the most common side effects of these drugs, including severe infections as well as rare opportunistic infections. Treating patients on biological DMARDs is therefore one of the biggest challenges in rheumatology care. The present review describes the current state of knowledge regarding frequency and type of infectious complications associated with biological DMARDs. The article focuses mainly on risk management, in particular on diagnosis and recurrence prevention of tuberculosis and reactivation of hepatitis B virus infection. Furthermore, we discuss the importance of vaccinations in primary disease prevention in patients with rheumatoid arthritis.
Zeitschrift für Rheumatologie 12/2010; 69(10):879-88. · 0.61 Impact Factor
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