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Certain vaccine responses diminish in patients with RA taking Xeljanz
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Patients with rheumatoid arthritis treated with Xeljanz, especially those taking methotrexate concomitantly, showed diminished response to the pneumococcal polysaccharide vaccine but not the 2011-2012 trivalent influenza vaccine, according to recently published research.
Researchers conducted two independent evaluations related to Xeljanz (tofacitinib citrate, Pfizer) treatment of patients with rheumatoid arthritis (RA). All patients met the 1987 American College of Rheumatology criteria for RA.
In the first study, 200 patients were randomly assigned at a 1:1 ratio to receive placebo or 10 mg tofacitinib twice daily. Serum pneumococcal and influenza antibody titers were collected 4 weeks after beginning tofacitinib therapy. After collection, patients were administered the influenza and 23-serotype pneumococcal polysaccharide vaccine (PPSV-23). Antibody titers were collected again after 35 days.
In the second study, a subgroup of 183 patients with RA participating in a long-term extension tofacitinib study who received 10 mg tofacitinib twice daily for at least 3 months were studied. Patients either continuously received tofacitinib or were randomly assigned to withdraw from treatment 1 week prior to vaccination, with treatment resumed 1 week after vaccination.
Serum pneumococcal and influenza antibody titers were collected prior to administration of the influenza and PPSV-23 vaccines. Antibody titers were collected again 35 days after vaccination.
Patients in the first study group treated with tofacitinib showed reduced responses to pneumococcal vaccination. Only 46 patients (45.1%) developed an adequate response compared with 67 (68.4%) of patients treated with placebo. The highest response rates were seen in patients who did not concomitantly use disease-modifying anti-rheumatic drugs. Further, only 18 patients receiving tofacitinib in combination with methotrexate developed satisfactory responses to the PPSV-23 vaccine, according to the researchers.
Similar numbers of patients in the first study group showed satisfactory response to the influenza vaccine, but the response after 35 days was significantly higher in the placebo group (91.8%) compared with the group that received tofacitinib (76.5%).
In the second study, patients on continuous therapy with tofacitinib showed diminished response to pneumococcal vaccination compared with the group withdrawn from treatment (75% vs. 84.6%), with the lowest response seen in patients concomitantly using methotrexate, according to the researchers. Satisfactory influenza vaccine immune responses were seen in all patients (66.3% continuous therapy vs. 63.7% in withdrawn therapy). - by Shirley Pulawski
Disclosure: Winthrop reports having received grants and consultancy fees from Pfizer. Please see the full study for a list of all other authors’ relevant financial disclosures.
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