Issue 20

Clinical Question

When patients with IBD receive vaccinations, is there a difference in seroprotection rates while they are being treated?

Editor’s Bottom Line

Seroprotection from vaccination is reduced (10%) by immunosuppression monotherapy and further reduced (20%) by biologic monotherapy or combination therapy, relative to non-immunosuppressed IBD controls.

Reference

Nguyen DL, Nguyen ET, Bechtold ML. Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis. Dig Dis Sci. 2015 Aug;60(8):2446–53. https://www.ncbi.nlm.nih.gov/pubmed/25796579

Synopsis

This meta-analysis examined the seroprotection achieved after vaccination in immunosuppressed versus non-suppressed IBD patients. Vaccinations examined were: hepatitis A, hepatitis B, influenza, and pneumococcus. Patients were grouped according to the type of immunosuppressive therapy: immunosuppressant monotherapy (azathioprine, 6-mercaptopurine, or methotrexate), biologic monotherapy (infliximab, adalimumab, or certolizumab pegol), and ≥2 immunosuppressants (including ≥20 mg/d prednisone) at the time of vaccination. Nine prospective case series (n=1,474) were evaluated.

Immunomodulator monotherapy reduced vaccination seroprotection success rate by approximately 10% relative to non-immunosuppressed IBD patients. Combination therapy and biologic monotherapy doubled the reduced vaccination seroprotection success rate to 20% relative to immunomodulatory monotherapy (see below).

Details

Study Design: Meta-analysis
Funding: None
Allocation: N/A
Setting: N/A
Level of Evidence: 2a (Oxford Levels of Evidence)

Not 1a rating since not all studies were RCTs with some being just case-controls and others just cohort studies. This paper describes the inclusion of “case series” but after checking the 9 papers, they are more 2a grading than 3a or 4a.

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.