Carmen Roseman (firstname.lastname@example.org}) Lennart Truedsson (email@example.com}) Meliha C Kapetanovic (firstname.lastname@example.org})
To study influence of cigarette smoking and alcohol consumption on immune response to heptavalent pneumococcal conjugate vaccine, immunoglobulin levels (Ig) and markers of systemic inflammation in patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA).
In total, 505 patients were vaccinated. Six prespecified groups were enrolled: RA on MTX treatment in some cases other DMARDs (I); RA on anti-TNF as monotherapy (II); RA on anti-TNF+MTX+ possibly other DMARDs (III); SpA on anti-TNF as monotherapy (IV); SpA on anti-TNF+MTX+ possibly other DMARDs (V); and SpA on NSAIDs and/or analgesics (VI). Smoking (pack-years) and alcohol consumption (g/week) were calculated from patient questionnaires. Ig, CRP and ESR were determined at vaccination. IgG antibodies against serotypes 23F and 6B were measured at vaccination and after 4-6 weeks using standard ELISA. Immune response (ratio between post- and prevaccination antibodies; IR) and positive immune response (≥ 2 fold increase in prevaccination antibodies; posIR) were calculated.
Eighty-eight patients (17.4%) were current smokers. Smokers had higher CRP and ESR, lower IgG and lower IR for both serotypes (p between 0.012 and 0.045). RA patients on MTX who smoked ≥ 1pack-year had lower posIR for both serotypes (p=0.021; OR 0.29; CI 0.1-0.7) compared to never-smokers. Alcohol consumption was associated with lower CRP (p=0.05) and ESR (p=0.003) but did not influence IR or Ig levels.
Smoking predicted impaired immune response to pneumococcal conjugate vaccine in RA patients on MTX. Smokers with arthritis had higher inflammatory markers and lower IgG regardless of diagnosis and treatment. Low to moderate alcohol consumption was related to lower levels of inflammation markers but had no impact on immune response.
Trial registration: EudraCT EU 2007-006539-29 and NCT00828997