Digestive Diseases and Sciences

, Volume 60, Issue 8, pp 2446–2453

Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis

  • Douglas L. Nguyen
  • Emily T. Nguyen
  • Matthew L. Bechtold
Original Article

DOI: 10.1007/s10620-015-3631-y

Cite this article as:
Nguyen, D.L., Nguyen, E.T. & Bechtold, M.L. Dig Dis Sci (2015) 60: 2446. doi:10.1007/s10620-015-3631-y

Abstract

Background

Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations.

Methods

A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel–Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response.

Results

In the pooled analysis of nine studies (N = 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55, p < 0.001). Specifically, we also demonstrated that patients on immunomodulator monotherapy had a twofold higher probability of achieving adequate immune response to vaccination, compared to patients on anti-tumor necrosis factor (anti-TNF) monotherapy (OR 1.92 95 % CI 1.30, 2.84).

Conclusion

In conclusion, IBD patients on immunosuppressive therapy have a significantly lower response to routine vaccinations. The greatest effect is seen among patients on anti-TNF and combination immunosuppressive therapy. Routine monitoring of vaccine titers post-vaccination is important to ensure that adequate immunologic response has been achieved among IBD patients.

Keywords

Immunosuppression Response to vaccination Anti-TNF therapy Inflammatory bowel disease 

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Douglas L. Nguyen
    • 1
  • Emily T. Nguyen
    • 2
  • Matthew L. Bechtold
    • 3
  1. 1.Department of Medicine, UC Irvine School of MedicineUniversity of California – IrvineOrangeUSA
  2. 2.Department of PharmacyUniversity of California – IrvineIrvineUSA
  3. 3.Department of MedicineUniversity of Missouri – ColumbiaColumbiaUSA

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