Live-attenuated vaccination in patients with inflammatory bowel disease while continuing or after elective switch to vedolizumab.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Intestinal Research Pub Date : 2024-07-01 Epub Date: 2024-03-26 DOI:10.5217/ir.2023.00203

Hisashi Shiga, Hiroshi Nagai, Yusuke Shimoyama, Takeo Naito, Rintaro Moroi, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune

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Abstract

Background/aims: Vedolizumab (VDZ) is a gut-selective agent with a favorable safety profile. We aimed to assess the feasibility of elective switch from other advanced therapies to VDZ and subsequent live-attenuated vaccination while continuing VDZ in patients with inflammatory bowel diseases (IBD).

Methods: We measured antibody titers specific for measles, rubella, mumps, and varicella viruses in IBD patients under immunosuppressive therapy. Those with negative titers and without vaccination history were judged unimmunized. Patients were administered vaccines while continuing VDZ or switched to VDZ if receiving other advanced therapies and then administered vaccines. Co-primary outcomes were the rate of maintaining disease severity after vaccination and the rate without vaccine-induced infection.

Results: Among 107 unimmunized patients, 37 agreed to receive live-attenuated vaccines while continuing VDZ (17 patients) or after switching to VDZ (20 patients). In the 20 patients who electively switched to VDZ, disease severity was maintained except for 1 patient who developed intestinal infection. After 54 weeks, 18 patients (90%) continued to receive VDZ, excluding 2 patients who reverted to their originally administered biologics. In all 37 patients administered live-attenuated vaccines under VDZ treatment, disease severity was maintained after vaccination. Antibody titers became positive or equivocal in 34 patients (91.9%). There were no cases of vaccine-induced infection during a median observation period of 121 weeks.

Conclusions: While live-attenuated vaccines are contraindicated under immunosuppressive therapy, they may be safely administered while receiving VDZ immunotherapy. Switching from other advanced therapies to VDZ and subsequently receiving live-attenuated vaccines may be a safe alternative in unimmunized patients.

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炎症性肠病患者在继续使用或选择改用维多珠单抗后接种减毒活疫苗。

背景/目的：韦多珠单抗（VDZ）是一种具有良好安全性的肠道选择性药物。我们旨在评估炎症性肠病（IBD）患者从其他先进疗法选择性转用 VDZ 并随后接种减毒活疫苗的可行性：我们测量了接受免疫抑制治疗的 IBD 患者体内的麻疹、风疹、腮腺炎和水痘病毒特异性抗体滴度。滴度阴性且无疫苗接种史的患者被判定为未免疫。患者在继续接受 VDZ 治疗的同时接种疫苗，或在接受其他先进疗法后改用 VDZ，然后接种疫苗。共同主要结果是接种疫苗后疾病严重程度的维持率和无疫苗诱发感染的比率：在 107 名未接受免疫接种的患者中，有 37 人同意在继续使用 VDZ（17 人）或转用 VDZ（20 人）后接种减毒活疫苗。在选择改用 VDZ 的 20 名患者中，除 1 名患者出现肠道感染外，其他患者的疾病严重程度均保持不变。54 周后，18 名患者（90%）继续接受 VDZ 治疗，其中不包括 2 名重新使用原先生物制剂的患者。在接受 VDZ 治疗的所有 37 位接种减毒活疫苗的患者中，接种疫苗后疾病的严重程度得以维持。34名患者（91.9%）的抗体滴度呈阳性或不稳定。在121周的中位观察期内，没有出现疫苗诱发感染的病例：尽管减毒活疫苗是免疫抑制疗法的禁忌症，但在接受VDZ免疫疗法时可以安全接种。对于未接受免疫治疗的患者来说，从其他先进疗法转为 VDZ 后再接种减毒活疫苗可能是一种安全的选择。

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来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.