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Sustainable Development Goals
03 Saúde e Bem-EstarCollections
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IMPACT OF SYNTHETIC AND BIOLOGICAL IMMUNOMODULATORY THERAPY ON THE DURATION OF 17DD YELLOW FEVER VACCINE-INDUCED IMMUNITY IN RHEUMATOID ARTHRITIS
Terapia imunomoduladora
Anticorpos neutralizantes
Artrite reumatoide
Immunomodulatory therapy
Neutralizing antibodies
Rheumatoid arthritis
Yellow fever vaccine
Vacina contra febre amarela
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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 YFspecific 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.
Keywords in Portuguese
Imunidade celularTerapia imunomoduladora
Anticorpos neutralizantes
Artrite reumatoide
Keywords
Cellular immunityImmunomodulatory therapy
Neutralizing antibodies
Rheumatoid arthritis
Yellow fever vaccine
Vacina contra febre amarela
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