Arthritis Research & Therapy (Mar 2019)

Impact of synthetic and biological immunomodulatory therapy on the duration of 17DD yellow fever vaccine-induced immunity in rheumatoid arthritis

  • Clarissa de Castro Ferreira,
  • Ana Carolina Campi-Azevedo,
  • Vanessa Peruhype-Magalhāes,
  • Jordana Grazziela Coelho-dos-Reis,
  • Lis Ribeiro do Valle Antonelli,
  • Karen Torres,
  • Larissa Chaves Freire,
  • Ismael Artur da Costa-Rocha,
  • Ana Cristina Vanderley Oliveira,
  • Maria de Lourdes de Sousa Maia,
  • Sheila Maria Barbosa de Lima,
  • Carla Magda Domingues,
  • Andréa Teixeira-Carvalho,
  • Olindo Assis Martins-Filho,
  • Lícia Maria Henrique da Mota,
  • on behalf of the Collaborative Group for Studies of Yellow Fever Vaccine

DOI
https://doi.org/10.1186/s13075-019-1854-6
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 12

Abstract

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Abstract Background The 17DD-yellow fever (YF) vaccine induces a long-lasting protective immunity, resulting from humoral and cellular immunological memory. The treatment of rheumatoid arthritis (RA) patients with disease-modifying anti-rheumatic drugs (DMARD) may affect pre-existing 17DD-vaccine protective immunity and increase the risk of acquiring YF infection. Our goal was to determine whether DMARD would affect the duration of YF-specific protective immunity in RA patients. Methods A total of 122 RA patients, previously immunized with the 17DD-YF vaccine (1–5, 5–9, and ≥ 10 years) and currently under DMARD therapy, were enrolled in the present investigation. Immunomodulatory therapy encompasses the use of conventional synthetic DMARD alone (csDMARD) or combines with biological DMARD (cs+bDMARD). A total of 226 healthy subjects were recruited as a control group (CONT). Neutralizing antibody responses were measured by a plaque-reduction neutralization test (PRNT), and cellular immunity was evaluated by an in vitro 17DD-YF-specific peripheral blood lymphoproliferative assay. Results The data demonstrated that csDMARD therapy did not affect the duration of protective immunity induced by the 17DD-YF vaccine compared to that of CONT, as both presented a significant time-dependent decline at 10 years after vaccination. Conversely, cs+bDMARD therapy induced a premature depletion in the main determinants of the vaccine protective response, with diminished PRNT seropositivity levels between 5 and 9 years and impaired effector memory in CD8+ T cells as early as 1–5 years after 17DD-YF vaccination. Conclusions These findings could support changing the vaccination schedule of this population, with the possibility of a planned booster dose upon the suspension of bDMARD in cases where this is allowed, even before 10 years following 17DD-YF vaccination. The benefit of a planned booster dose should be evaluated in further studies. Trial registration RBR-946bv5. Date of registration: March 05, 2018. Retrospectively registered

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