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The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: A systematic review and meta-analysis

机译：免疫抑制剂对肺炎球菌疫苗接种免疫原性的影响：系统评价和荟萃分析

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摘要

IntroductionPatients with a weakened immune system due to immunosuppressive treatment are at increased risk of infection withStreptococcus pneumoniae. Although pneumococcal vaccination is highly recommended for those patients, the effectiveness of pneumococcal vaccination in this population remains largely unknown. Therefore, the objective of this PROSPERO-registered systematic review and meta-analysis was to evaluate the effect of the most commonly prescribed immunosuppressive agents such as azathioprine, methotrexate, anti-Tumor Necrosis Factor α (TNFα), or rituximab, on the initial serologic response to pneumococcal vaccination in patients with auto-immune disease.MethodsWe included 22 articles comprising 2077 patients, of whom 1623 were treated with immunosuppressive agents, and 454 were controls.Results and discussionThe findings of our systematic review indicate that, in patients treated with immunosuppressive medication and compared to controls, the initial serologic response to pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are impaired. Moreover, this impaired response was more profound after PCV than after PPSV. We hypothesize that the immunosuppressive medication mainly compromises the cellular immunity, explaining the more severely reduced response rate to PCV (which induces a T-cell dependent immune response), compared to PPSV. Treatment with TNFα blocking agents was associated with a more favorable response, compared to patients treated with other immunosuppressive medication. Targeted research applying uniform correlates of protection is needed to bridge the knowledge gap in vaccination immunology in this patient group.PROSPERO registration: CRD42017058364.
机译：由于免疫抑制治疗导致的免疫系统弱化的介绍是肺炎链球菌感染的风险增加。虽然适用于这些患者的肺炎球菌疫苗接种，但这种人群中肺炎球菌疫苗接种的有效性仍然很大程度上是未知的。因此，这种翻译的系统审查和荟萃分析的目的是评估最常见规定的免疫抑制剂如偶氮嘌呤，甲氨蝶呤，抗肿瘤坏死因子α（TNFα）或Rituximab对最初的血清素的影响对患有自身免疫疾病患者的肺炎球菌疫苗接种。含有22种包含2077名患者的物品，其中1623名用免疫抑制剂治疗，454名是对照。结果和讨论我们系统审查的结果表明，在用免疫抑制治疗的患者中表明药物和与对照相比，对肺炎球菌缀合物疫苗（PCV）和肺炎球菌多糖疫苗（PPSV）的初始血清学反应受到损害。此外，PCV后，这种损害的反应比PPSV在PPSV之后更加深刻。与PPSV相比，我们假设免疫抑制药物主要损害细胞免疫力，解释对PCV的响应率更严重降低（诱导T细胞依赖性免疫应答）。与用其他免疫抑制药物治疗的患者相比，用TNFα阻断剂处理与更有利的反应相关。需要统一的研究统一相关的保护，以弥合本患者Group.Prospero注册：CRD42017058364。

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  • 来源
    《Vaccine》 |2018年第39期|共14页
  • 作者

    Mari?lle van Aalst; Annefleur C. Langedijk; René Spijker; Godelieve J. de Bree; Martin P. Grobusch; Abraham Goorhuis;

  • 作者单位

    Centre of Tropical Medicine and Travel Medicine Department of Infectious Diseases Academic Medical Center University of Amsterdam;

    Centre of Tropical Medicine and Travel Medicine Department of Infectious Diseases Academic Medical Center University of Amsterdam;

    Medical Library Academic Medical Center;

    Centre of Tropical Medicine and Travel Medicine Department of Infectious Diseases Academic Medical Center University of Amsterdam;

    Centre of Tropical Medicine and Travel Medicine Department of Infectious Diseases Academic Medical Center University of Amsterdam;

    Centre of Tropical Medicine and Travel Medicine Department of Infectious Diseases Academic Medical Center University of Amsterdam;

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  • 原文格式 PDF
  • 正文语种 other
  • 中图分类 医学免疫学;
  • 关键词

    Pneumococcal vaccination; Immunogenicity; Auto-immune disease; Immunosuppressive therapy; PCV; PPSV;

    机译：肺炎球菌疫苗接种;免疫原性;自身免疫疾病;免疫抑制治疗;PCV;PPSV;

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