接受阿巴西普治疗的类风湿关节炎患者仍可从疫苗接种中获益

作者：Kiyoshi Migita 等   翻译：李常虹

发布者：翟佳羽 审校者：李常虹

背景：

使用阿巴西普治疗的类风湿关节炎患者可增加疫苗接种后感染发生的风险。本研究旨在评估使用阿巴西普治疗的类风湿关节炎患者接种肺炎球菌多糖疫苗后体液反应情况。

方法：

本研究是一随机双盲安慰剂对照研究的一部分，该随机研究旨在评估肺炎球菌多糖疫苗的疗效。共111例类风湿关节炎患者接种该疫苗，后分为3组：类风湿关节炎对照组（35例）、MTX单药治疗组（55例）和阿巴西普治疗组（21例）。免疫接种前和接种后4-6周，采用ELISA和多重调理吞噬杀伤实验分别评估血清型特异性抗体滴度和抗体的功能，并计算调理指数。

结果：

所有针对肺炎球菌多糖疫苗做出免疫反应的患者体内血清型特异性IgG抗体滴度和调理指数均显著升高。在使用阿巴西普治疗组，针对6B血清型的特异性IgG反应要低于MTX单药治疗组或对照组，而调理指数与后两组相当。亚组分析显示阿巴西普+MTX治疗组的肺炎球菌特异性抗体IgG反应（针对6B和23F）显著降低，而调理指数反应在阿巴西普治疗组中与其他两组没有差异。与对照组或MTX单药治疗组相比，使用阿巴西普治疗的患者中血清型特异性IgG反应和调理指数反应之间无相关性。在所有治疗组中均未发现严重的不良反应。

结论：

调理指数反应代表了抗体的功能而不是简单的抗体数量，所以研究结果提示使用阿巴西普治疗的类风湿关节炎患者仍能从接种肺炎球菌多糖疫苗中获益，但产生的IgG反应相对降低。该研究结果提示阿巴西普对于肺炎球菌介导的体液免疫反应的影响小于MTX，然而，阿巴西普+MTX联合治疗不影响免疫接种后的抗体调理反应。

附原文：

Introduction: Patientswith rheumatoid arthritis (RA) treated with abatacept (ABT) are at increasedrisk for vaccine-preventable infections. The aim of the present study is toevaluate the humoral response to 23-valent pneumococcal polysaccharide (PPSV23)vaccination in RA patients receiving ABT. Methods: The immunogenicity study wasnested within a randomized, double-blind placebo-controlled study, designed toevaluate the efficacy of the PPSV23. PPSV23 was given to 111 RA patients, whowere classified into three groups: RA control (n=35),methotrexate (MTX) alone (n=55), and ABT (n=21).Before and 4–6 weeks after vaccination, we measured the patients’concentrations of antibodies against pneumococcal serotypes 6B and 23F using anenzyme-linked immunosorbent assay and determined their antibody functionalityusing a multiplexed opsonophagocytic killing assay, reported as theopsonization index (OI). Results: The pneumococcal serotype-specific IgGconcentrations and OIs were both significantly increased in all treatmentgroups in response to PPSV23 vaccination. In the ABT group, the IgG responsesfor the 6B serotype were lower compared with those in the MTX alone or controlgroups, whereas the OI responses were similar to those in the other two groups.In a subgroup analysis, the pneumococcal serotype-specific IgG responses weresignificantly lower in both serotypes (6B and 23F) in the ABT/MTX group;however, the OI responses in the ABT group were not different from the controlgroup. There was no association between the pneumococcal serotype-specific IgGand OI responses for the 6B serotype in patients receiving ABT in contrast tothe control or MTX alone patients. No severe adverse effects were observed inany of the treatment groups. Conclusions: OI responses indicate antibodyfunctionality rather than simply their amount, so the similarity of thesemeasurements between all three groups suggests that RA patients receiving ABTstill benefit from receiving the PPSV23 vaccination, even though they produceless IgG in response to it. The results suggest an influence of ABT on thehumoral response to PPSV23 vaccination under MTX treatment; however, preservedopsonin responses are expected in RA patients treated with ABT plus MTX.

引自：

Kiyoshi Migita,Yukihiro Akeda, Manabu Akazawa, et al.Effectof abatacept on the immunogenicity of 23-valent pneumococcal polysaccharidevaccination (PPSV23) in rheumatoid arthritis patients. Arthritis Research&Therapy201517:357.DOI: 10.1186/s13075-015-0863-3

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