Background/Purpose: Disease modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX) and biologics were ported to attenuate response to a previous 23-prevalent pneumococcal polysaccharide vaccine. Recently, a 13-prevalent pneumococcal conjugate vaccine (PCV13) for adults became easily available but clinical outcome has never been evaluated. Here, we investigated clinical outcomes and associated factors of severe pneumonia after PCV13 administration.

Methods: : We searched patients who received 13-prevalent pneumonoccal vaccine rheumatologic clinic of Cheonan Soonchunhyang university hospital. Severe pneumonia defined as pneumonia requiring in-hospital treatment. We investigated history of severe pneumonia and underlying lung disease including interstitial lung disease (ILD), asthma, chronic obstructive pulmonary disease (COPD) and pneumoconiosis. A total cumulative dose of glucocorticoid and history administration of biologics or DMARDs after PCV13 injection was also investigated. The Chi-Square or Fisher’s exact test and Mann-Whiteney test was used assessing association between above mentioned factors and severe pneumonia as appropriate.

Results:

Among a total of 123 patients, female was 82.1 % (101/123) and the mean (standard deviation, SD) follow-up duration was 22.2 (8.0) weeks. The mean (SD) age were age 54.7 ± 14.2 equal or 34 of 123 patients (27.6%) were more than 65 year-old. Thirteen patients had underlying lung disease: ILD= 4, asthma or COPD = 7, bronchiectasis = 6 and pneumoconiosis = 1. One- hundred-four (84.6%), 97 (78.9%), 40 (32.5) and 38 (30.9%) patients were experienced MTX, hydroxycholoroquine, sulfasalazine, and leflunomide respectively. Numbers of patients who had history of biologics use during follow-up duration were as follows: adalimumab 31 (35.2%), etanercept 7 (5.7%), infliximab 10 (8.1%), golimumab 4 (3.3%), tocilizumab 6 (4.9%), and abatacept 5 (4.1%). The mean (SD) of cumulative glucocorticoid dose was 2875.6 (2475.8) of prednisolone. After PCV13, 5.7% (7/123) of patients had severe pneumonia requiring in-hospital treatment during a mean of 22.2 weeks of follow-up. The presence of underlying lung disease (p = 1.1 x 10^-4 by Fisher’s exact test) and a total cumulative glucocorticoid dose (p = 0.014 by Mann-Whitney test) was associated with development of severe pneumonia but age ( ≥ 65 year-old) or other medication including DMARDs and biologics was not.

Conclusion:

After PCV13 administration, development of severe pneumonia was associated with underlying lung conditions and cumulative glucocorticoid dose but not with age or biologics use.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/severe-pneumonia-after-a-13-prevalent-pneumonoccal-conjugate-vaccine-prevena-13-among-patients-with-rheumatoid-arthritis/