Ann Intern Med:接受肿瘤坏死因子抑制剂治疗的患者接种水痘-带状疱疹活疫苗的安全性和免疫学效果

2022-01-07 MedSci原创 MedSci原创

在接受免疫调节治疗(如肿瘤坏死因子抑制剂(TNFis))的炎症性疾病患者中,水痘-带状疱疹疫苗等活病毒疫苗的安全性和有效性尚不清楚。

在接受免疫调节治疗(如肿瘤坏死因子抑制剂(TNFis))的炎症性疾病患者中,水痘-带状疱疹疫苗等活病毒疫苗的安全性和有效性尚不清楚。近日,发表于Ann Intern Med的一项研究评估了水痘减毒活疫苗(ZVL)在接受TNFis治疗的患者中的安全性和免疫原性。

采用随机、盲法、安慰剂对照设计,纳入接受TNFis治疗的50岁及以上的成年人,随机分配到ZVL与安慰剂。基线和接种后6周测量血清和外周血单核细胞的糖蛋白酶联免疫吸附试验(gpELISA)和酶联免疫吸附点(ELISpot)。通过数码照片和水泡液的聚合酶链反应评估疑似水痘或带状疱疹感染

 

结果,2015年3月至2018年12月,研究共纳入617名参与者,在33个中心按1:1的比例随机分配接受ZVL(n = 310)或安慰剂(n = 307)。平均年龄为62.7岁(SD,7.5);66.1%的参与者为女性,90%为白人,8.2%为黑人,5.9%为西班牙裔。最常见的TNFi适应症是类风湿性关节炎(57.6%)和银屑病关节炎(24.1%);TNFi药物有阿达木单抗(32.7%)、英夫利西单抗(31.3%)、依那西普(21.2%)、戈利木单抗(9.1%)和塞托珠单抗(5.7%)。同时进行的治疗包括甲氨蝶呤(48.0%)和口服糖皮质激素(10.5%)。到第6周,没有发现确诊的水痘感染病例;水痘感染或带状疱疹的累积发生率为0.0%(95%CI,0.0%-1.2%)。在6周时,与基线相比,通过gpELISA和ELISpot测量的几何平均倍数上升的平均值分别为1.33个百分点(CI,1.17-1.51%)和1.39个百分点(CI,1.07-1.82%)。

 

综上所述,该研究结果为接受生物制剂的患者使用活病毒疫苗的安全问题提供了依据。研究的局限性在于对接受其他类型的免疫调节剂的患者的普遍性可能有限。

 

原始出处:

 

Jeffrey R Curtis, et al., The Safety and Immunologic Effectiveness of the Live Varicella-Zoster Vaccine in Patients Receiving Tumor Necrosis Factor Inhibitor Therapy : A Randomized Controlled Trial. Ann Intern Med. 2021 Nov;174(11):1510-1518. doi: 10.7326/M20-6928.

 

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2022, time=2022-01-09, status=1, ipAttribution=)]
  5. 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href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Sun Jan 09 14:32:19 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611403, encodeId=114216114036e, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sun Jan 09 14:32:19 CST 2022, time=2022-01-09, status=1, ipAttribution=)]
    2022-01-09 millore
  6. 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  7. 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  8. 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