Pneumococcal vaccination such as PCV13 and PPV23 is recommended in RA patients due to the substantial risk of pneumococcal infections. However, previous studies have reported that different DMARDs induce variable impacts on antibody response of pneumococcal vaccines. On contrary, a recent study published in Modern Rheumatology reported that janus kinase inhibitors (JAKIs) do not weaken the antibody response of pneumococcal conjugate vaccine (PCV13) immunogenicity in RA patients.
The study carried out by Shunsuke Mori and co-researchers included a total of 53 RA patients. The corresponding number of subjects administered with MTX monotherapy, JAKI monotherapy, and combination MTX and JAKI were 10, 20, and 23, and they were subsequently vaccinated with PCV13. A significant increase in IgG concentrations was noted in reaction to 13 pneumococcal serotypes in all the treatment groups and the corresponding varied increase in the fold of IgG levels noted in MTX, JAKI, and combination therapy groups were 9.30, 6.36, and 3.46. When compared to the MTX group, the combination therapy group showed a low-fold increase. The positive antibody response rates noted were similar for the JAKI group and MTX groups (95% and 90%), although a low rate of 52% was observed for combination therapy. An association was proved between combination therapy and decreased antibody response to PCV13 by multivariable logistic regression analysis. Moreover, no events of severe adverse effects or RA flares were observed.
The researchers have concluded that JAKIs do not impair pneumococcal conjugate vaccine immunogenicity in RA patients. The present study corroborates the usefulness of JAKI monotherapy in RA patients with high disease activity for achieving an adequate response to the vaccine. However, it cautions that MTX -JAKI combination can reduce the antibody response.
Reference: Mori S, Ueki Y, Ishiwada N. Impact of Janus Kinase Inhibitors on Antibody Response to 13-Valent Pneumococcal Conjugate Vaccine in Patients with Rheumatoid Arthritis. Mod Rheumatol. 2022 Mar 26:roac029.