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Pneumococcal Vaccine Response in Psoriatic Arthritis Patients During Treatment with Etanercept
PHILLIP J. MEASE, CHRISTOPHER T. RITCHLIN, RICHARD W. MARTIN, ALICE B. GOTTLIEB, SCOTT W. BAUMGARTNER, DANIEL J. BURGE, and JAMES B. WHITMORE
ABSTRACT.
Methods. Patients with PsA (n = 205) were stratified by methotrexate (MTX) use and randomly assigned to receive either placebo or etanercept 25 mg twice weekly by subcutaneous injection. After 4 weeks of treatment with study drug, a 23-valent pneumococcal vaccination was administered. Antibody levels to 5 antigens (9V, 14, 18C, 19F, and 23F) were measured by ELISA before and 4 weeks after vaccination in 184 patients. The proportion (%) of patients with 2- and 4-fold increases in antibody titers was analyzed. Results. Patients treated with etanercept or placebo had similar responses to the vaccine. A 2-fold increase in titer to at least 2 antigens was achieved by 67% of patients, and a 4-fold increase to at least 2 antigens was achieved by 47% of patients. Approximately 20% of patients in each group failed to show a 2-fold response to any antigens. Logistic regression analysis showed MTX use and age were predictors of a poor response. Conclusions. Patients with PsA treated with etanercept were able to produce antibodies in response to pneumococcal vaccination. Patients receiving MTX had lower mean antibody levels in response to the vaccine. There was no increased risk of poor response with etanercept treatment given alone or with MTX. (J Rheumatol 2004;31:1356-61) Key Indexing Terms:
ETANERCEPT
From Seattle Rheumatology Associates, Seattle, Washington; University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York; College of Human Medicine, Michigan State University, Grand Rapids, Michigan; Clinical Research Center, UMDNJ, Robert Wood Johnson Medical School, New Brunswick, New Jersey; The Physicians' Clinic of Spokane, Spokane, WA; and Amgen Inc., Thousand Oaks, California, USA. Supported by Immunex Corporation, a wholly owned subsidiary of Amgen Inc., and by Wyeth. P.J. Mease, MD, Seattle Rheumatology Associates; C.T. Ritchlin, MD, University of Rochester Medical Center, Strong Memorial Hospital; R.W. Martin, MD, MA, College of Human Medicine, Michigan State University; A.B. Gottlieb, MD, PhD, Clinical Research Center, UMDNJ Robert Wood Johnson Medical School; S.W. Baumgartner, MD, Clinical Rheumatology, The Physicians Clinic of Spokane; D.J. Burge, MD; J.B. Whitmore, PhD, Amgen Inc. Address reprint requests to Dr. P.J. Mease, Seattle Rheumatology Associates, 1101 Madison, Suite 230, Seattle, WA 98104. E-mail: pmease@nwlink.com Submitted September 15, 2003; revision accepted January 22, 2004. |