scholarly journals THU0267 SERUM IGG2 LEVELS PREDICT VERY LONG-TERM PROTECTION FOLLOWING PNEUMOCOCCAL VACCINE IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 360.3-360
Author(s):  
T. Goulenok ◽  
A. L. Gerard ◽  
M. Bahuaud ◽  
P. Aucouturier ◽  
H. Moins ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pneumococcal Infection ◽  
Pneumococcal Vaccination ◽  
Immune Protection ◽  
Systemic Lupus ◽  
Baseline Serum ◽  
Increased Risk ◽  
Immune Efficacy

Background:Systemic lupus erythematosus (SLE) patients are at increased risk forStreptococcus pneumoniaeinfection. Although pneumococcal vaccination is an attractive method to prevent invasive pneumococcal infection, vaccination coverage remains dramatically low in SLE. Moreover, the efficacy of vaccination may be reduced in SLE patients and sequential pneumococcal vaccination using new conjugated pneumococcal vaccines in combination with 23-valent pneumococcal polysaccharide vaccine (PPV23) is now advocated. However, limited study directly addressed the immune efficacy of such prime-and-boost strategy in SLEObjectives:We aimed to measure the immunological efficacy of the sequential pneumococcal vaccination using PCV13 in combination with PPV23 and identify factors associated with long-term immune protection following vaccination in SLE.Methods:SLE patients received PCV13 vaccine followed by PPSV23 vaccine 8 weeks later. Immune protection, defined by an antigen-specific IgG concentration ≥ 1.3 µg/mL for at least 70% of 7 pneumococcal serotypes (4, 6B, 9V, 14, 18C, 19F, 23F), was assessed at baseline, 2 months, 12 months, and 36 months, defining very long-term protection.Results:21 (40[25-75] years; 85.7% female) SLE patients received the sequential PCV13/PPV23 vaccines. Only 10 (47.6%) showed a sustained immune protection against pneumococcal infection 36 months after PCV13 shot (very long-term protected, VLTP). Eleven patients had no long-term protection (NLTP) with a seroconversion that never (n=6) or only transiently (n=5) occurred. SLE disease features, treatment received and immunological characteristic did not differ between VLTP and NLTP patients except for a lower serum IgG2 levels in NLTP (1.45 [1.30, 1.82] vs 3.30 [2.92, 4.44] g/L, p<0.001). Noteworthy the ROC curve showed that the serum IgG2 level before vaccination (AUC 0.95 [95% CI: 0.84-1]; p=0.004) was predictive for very long-term protection. A baseline serum IgG2 level of 2.125µg/ml or more showed a sensitivity of 100% and a specificity of 90.9% for very long-term protectionConclusion:The benefit of sequential PCV13/PPV23 vaccination in SLE is limited. Baseline IgG2 serum level before vaccination is strongly indicative of very long term protection following vaccinationDisclosure of Interests:None declared

scholarly journals Improving Pneumococcal Vaccination Rates in Rheumatology Clinics

2021 ◽  
pp. jrheum.210058
Author(s):  
Julia G. Harris
Keyword(s):  
Systemic Lupus Erythematosus ◽  
General Population ◽  
Lupus Erythematosus ◽  
Pneumococcal Disease ◽  
Pneumococcal Infection ◽  
Pneumococcal Vaccination ◽  
Systemic Lupus ◽  
Vaccination Rates ◽  
Increased Risk ◽  
Invasive Pneumococcal Infection

Rheumatology patients on immunosuppression are at increased risk of invasive pneumococcal disease. There is a multitude of literature highlighting the risk of pneumococcal infection, hospitalization, and even death in patients with systemic lupus erythematosus (SLE), in whom incidence of invasive pneumococcal infection is 13 times higher than the general population. 1,2,3,4

scholarly journals Damage accrual and mortality over long-term follow-up in 300 patients with systemic lupus erythematosus in a multi-ethnic British cohort

Rheumatology ◽  
2019 ◽  
Author(s):  
Beatriz Tejera Segura ◽  
Brett Sydney Bernstein ◽  
Thomas McDonnell ◽  
Chris Wincup ◽  
Vera M Ripoll ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Concomitant Disease ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Damage Accrual ◽  
Long Term Follow Up

Abstract Objective Damage in patients with systemic lupus erythematosus is irreversible change in organs due to disease activity, concomitant disease or medication side-effects. It is measured using the Systemic Lupus International Collaborative Clinics Damage Index (SDI) and is associated with increased mortality. Previous reports have suggested associations between damage accrual and various ethnic, disease and treatment factors, but there is a dearth of long-term follow-up data from large multi-ethnic cohorts. We describe a study of damage and mortality in 300 patients from London, UK followed for up to 40 years. Methods We carried out retrospective analysis of medical records and SDI scores of 300 patients followed for up to 40 years (median 13.3 years). Characteristics of the groups who did and did not develop damage and those who died or survived to the end of follow-up were compared using univariable and multivariable analysis. Kaplan-Meier analysis was used to analyse factors affecting mortality and accrual of damage. Results Damage developed in 231/300 (77%) of patients. There was a linear accrual of damage over 40 years follow-up. Factors associated with damage were African/Caribbean ethnicity, renal and cerebral involvement, early use of high-dose corticosteroids or immunosuppressants, anti-RNP and antiphospholipid antibodies. Damage was strongly associated with mortality. Of 87 patients who died, 93% had damage compared with 70% of survivors (P < 0.001). Conclusion Development of damage is strongly associated with increased mortality. We identified groups at increased risk of developing damage, including those treated with high-dose steroids and immunosuppressants within the first two years.

scholarly journals Improving the Combination Pneumococcal Vaccination Rate in Systemic Lupus Erythematosus Patients at an Adult Rheumatology Practice

2018 ◽  
Vol 45 (12) ◽  
pp. 1656-1662 ◽  
Author(s):  
Shivani Garg ◽  
Katina Tsagaris ◽  
Raluca Cozmuta ◽  
Aliza Lipson
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pneumococcal Infection ◽  
Pneumococcal Vaccination ◽  
Vaccination Rate ◽  
Practice Change ◽  
Systemic Lupus ◽  
Team Members ◽  
Vaccination Rates ◽  
Rheumatology Practice

Objective.The risk of developing invasive pneumococcal infection is 13 times higher in patients with systemic lupus erythematosus (SLE) in comparison with the general population. The US Centers for Disease Control and Prevention anticipates a US$7.6 million medical cost reduction by providing pneumococcal vaccination. The objective of this study was to improve the rate of combination pneumococcal vaccination (pneumococcal polysaccharide vaccine 23 + pneumococcal conjugate vaccine 13) in patients with SLE in our adult academic rheumatology practice.Methods.With the use of physician- and staff-based surveys, we analyzed the underlying barriers in providing vaccination. We then planned a multifaceted intervention including pre-visit planning, day-of-visit planning, weekly review, and monthly feedback.Results.Our project is one of the few studies planned to improve combination pneumococcal vaccination rates in adult patients with SLE and we report an impressive improvement from 10% baseline rate to 59% vaccination rate by the end of the study period. This highlights the role of planning an intervention with an integrated workflow and the importance of sharing performance data, which leads to high compliance among team members.Conclusion.The significant improvement in combination vaccination rate in eligible patients with SLE and the additional rise of vaccine rates seen in other eligible patients in the practice draws attention to the high adaptiveness of the intervention resulting in a true practice change. Our quality project design can serve as a model that can be adapted by other specialty clinics to achieve higher vaccination standards.

Serum IgG2 levels predict long-term protection following pneumococcal vaccination in systemic lupus erythematosus (SLE)

Vaccine ◽  
2020 ◽  
Vol 38 (44) ◽  
pp. 6859-6863
Author(s):  
Anne-Laure Gerard ◽  
Tiphaine Goulenok ◽  
Mathilde Bahuaud ◽  
Chrystelle Francois ◽  
Pierre Aucouturier ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pneumococcal Vaccination ◽  
Systemic Lupus

Impaired long-term immune protection following pneumococcal 13-valent/23-valent polysaccharide vaccine in systemic lupus erythematosus (SLE)

2018 ◽  
Vol 77 (10) ◽  
pp. 1540-1542 ◽  
Author(s):  
Karim Sacre ◽  
Tiphaine Goulenok ◽  
Mathilde Bahuaud ◽  
Chrystel Francois ◽  
Marie Claude Van der Haegen ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Polysaccharide Vaccine ◽  
Immune Protection ◽  
Systemic Lupus

Long-Term Treatment of the Patient with Systemic Lupus Erythematosus

1975 ◽  
Vol 37 (6) ◽  
pp. 924-929 ◽  
Author(s):  
Hideaki YAMAURA ◽  
Masaharu RIKIMARU ◽  
Isamu TAKAHASHI ◽  
Sadao ANAN ◽  
Tomio AKIYAMA ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Term Treatment ◽  
Systemic Lupus ◽  
Long Term Treatment

scholarly journals Phase 1 double-blind randomized safety trial of the Janus kinase inhibitor tofacitinib in systemic lupus erythematosus

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Sarfaraz A. Hasni ◽  
Sarthak Gupta ◽  
Michael Davis ◽  
Elaine Poncio ◽  
Yenealem Temesgen-Oyelakin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Kinase Inhibitor ◽  
Janus Kinase ◽  
Controlled Clinical Trial ◽  
Type I ◽  
Systemic Lupus ◽  
Double Blind ◽  
Premature Cardiovascular Disease ◽  
Increased Risk

AbstractIncreased risk of premature cardiovascular disease (CVD) is well recognized in systemic lupus erythematosus (SLE). Aberrant type I-Interferon (IFN)-neutrophil interactions contribute to this enhanced CVD risk. In lupus animal models, the Janus kinase (JAK) inhibitor tofacitinib improves clinical features, immune dysregulation and vascular dysfunction. We conducted a randomized, double-blind, placebo-controlled clinical trial of tofacitinib in SLE subjects (ClinicalTrials.gov NCT02535689). In this study, 30 subjects are randomized to tofacitinib (5 mg twice daily) or placebo in 2:1 block. The primary outcome of this study is safety and tolerability of tofacitinib. The secondary outcomes include clinical response and mechanistic studies. The tofacitinib is found to be safe in SLE meeting study’s primary endpoint. We also show that tofacitinib improves cardiometabolic and immunologic parameters associated with the premature atherosclerosis in SLE. Tofacitinib improves high-density lipoprotein cholesterol levels (p = 0.0006, CI 95%: 4.12, 13.32) and particle number (p = 0.0008, CI 95%: 1.58, 5.33); lecithin: cholesterol acyltransferase concentration (p = 0.024, CI 95%: 1.1, −26.5), cholesterol efflux capacity (p = 0.08, CI 95%: −0.01, 0.24), improvements in arterial stiffness and endothelium-dependent vasorelaxation and decrease in type I IFN gene signature, low-density granulocytes and circulating NETs. Some of these improvements are more robust in subjects with STAT4 risk allele.

A Long-Term Study of Hydroxychloroquine Withdrawal on Exacerbations in Systemic Lupus Erythematosus

Lupus ◽  
1998 ◽  
Vol 7 (2) ◽  
pp. 80-85 ◽  
Author(s):  
◽  
E Tsakonas ◽  
L Joseph ◽  
J M Esdaile ◽  
D Choquette ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Term Study ◽  
Long Term Study
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