The Effect of Tumor Necrosis Factor Blockade on the Response to Pneumococcal Vaccination in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis

Ori Elkayam, Dan Caspi, Tatiana Reitblatt, Darlene Charboneau, Jeffrey B. Rubins

Research output: Contribution to journalArticlepeer-review

147 Scopus citations


Objective: To assess the effect of anti-tumor necrosis factor (TNF) α therapies on the immunogenicity of pneumococcal vaccination in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: A group of 16 consecutive patients (11 with RA and 5 with AS) treated either with infliximab or etanercept, and a control group of 17 age-matched RA patients treated with disease-modifying medications other than anti-TNF-α, received intradeltoid injection with 0.5 mL of pneumococcal vaccine. Pneumococcal polysaccharide (PPS)-specific IgG to 7 vaccine PPS (representing high- and low-prevalence serotypes) was measured by enzyme-linked immunosorbent assay in sera obtained before and 1 month after pneumococcal immunization. Results: One month after vaccination, both groups had significant increases in the geometric mean concentration of capsule PPS-specific antibody and in the mean fold increase in antibody levels to all 7 serotgpes, compared with prevaccination levels. However, compared with the control group, the TNF-α blockade-treated patients tended to have lower antibody increases for all the serotypes tested except serotype 14. In addition, lower proportions of TNF-α blockade-treated patients responded to pneumococcal vaccination compared with patients on other therapies. Similarly, more TNF-α blockade-treated patients were poor responders compared with patients not on anti-TNF-α treatment. Conclusion: Treatment of groups of patients with etanercept or infliximab does not impair their mean antibody responses to pneumococcal vaccination. However, a larger proportion of RA patients may not respond adequately to pneumococcal vaccination once on TNF-α blockade therapies. Consequently, pneumococcal vaccination before starting TNF-α blockade therapy is recommended.

Original languageEnglish (US)
Pages (from-to)283-288
Number of pages6
JournalSeminars in Arthritis and Rheumatism
Issue number4
StatePublished - Feb 2004

Bibliographical note

Funding Information:
Supported by National Institutes of Health Grant IH AI02440 (to J.B.R.).

Copyright 2017 Elsevier B.V., All rights reserved.


  • Ankylosing spondylitis
  • Immunization
  • Immunotherapy
  • Rheumatoid arthritis
  • Streptococcus pneumoniae
  • Tumor necrosis factor


Dive into the research topics of 'The Effect of Tumor Necrosis Factor Blockade on the Response to Pneumococcal Vaccination in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis'. Together they form a unique fingerprint.

Cite this