Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis

Konstantinos Thomas; Argyro Lazarini; Evripidis Kaltsonoudis; Paraskevi V Voulgari; Alexandros A Drosos; Argyro Repa; Ainour Molla Ismail Sali; Prodromos Sidiropoulos; Panagiota Tsatsani; Sousana Gazi; Kalliopi Fragkiadaki; Maria G Tektonidou; Petros P Sfikakis; Pelagia Katsimbri; Dimitrios Boumpas; Evangelia Argyriou; Kyriaki A Boki; Konstantina Karagianni; Christina Katsiari; Gerasimos Evangelatos; Alexios Iliopoulos; Eleftheria P Grika; Panagiotis G Vlachoyiannopoulos; Theodoros Dimitroulas; Alexandros Garyfallos; Konstantinos Melissaropoulos; Panagiotis Georgiou; Constantinos Georganas; Periklis Vounotrypidis; Konstantinos Ntelis; Maria Areti; George D Kitas; Dimitrios Vassilopoulos

doi:10.3389/fmed.2022.1039464

Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis

Front Med (Lausanne). 2023 Jan 9:9:1039464. doi: 10.3389/fmed.2022.1039464. eCollection 2022.

Authors

Konstantinos Thomas¹, Argyro Lazarini¹, Evripidis Kaltsonoudis², Paraskevi V Voulgari², Alexandros A Drosos², Argyro Repa³, Ainour Molla Ismail Sali³, Prodromos Sidiropoulos³, Panagiota Tsatsani⁴, Sousana Gazi⁴, Kalliopi Fragkiadaki¹, Maria G Tektonidou¹, Petros P Sfikakis¹, Pelagia Katsimbri¹, Dimitrios Boumpas¹, Evangelia Argyriou⁵, Kyriaki A Boki⁵, Konstantina Karagianni⁶, Christina Katsiari⁶, Gerasimos Evangelatos⁷, Alexios Iliopoulos⁷, Eleftheria P Grika¹, Panagiotis G Vlachoyiannopoulos¹, Theodoros Dimitroulas⁸, Alexandros Garyfallos⁸, Konstantinos Melissaropoulos⁹, Panagiotis Georgiou⁹, Constantinos Georganas¹⁰, Periklis Vounotrypidis¹¹, Konstantinos Ntelis¹², Maria Areti¹³, George D Kitas^{1

14}, Dimitrios Vassilopoulos¹

Affiliations

¹ Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
² Rheumatology Clinic, University of Ioannina, Ioannina, Greece.
³ Department of Clinical Immunology and Allergy, University of Crete, Heraklion, Greece.
⁴ Rheumatology Unit, KAT Hospital, Athens, Greece.
⁵ Rheumatology Unit, Sismanoglio Hospital, Athens, Greece.
⁶ Department of Rheumatology, University of Thessaly, Larissa, Greece.
⁷ Rheumatology Unit, NIMTS Hospital, Athens, Greece.
⁸ 4th Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁹ Rheumatology Unit, Agios Andreas Hospital, Patras, Greece.
¹⁰ Private Practitioner, Athens, Greece.
¹¹ Private Practitioner, Thessaloniki, Greece.
¹² Private Practitioner, Kalamata, Greece.
¹³ Private Practitioner, Leivadia, Greece.
¹⁴ Hygeia Hospital, Athens, Greece.

Abstract

Introduction: Patients with rheumatoid arthritis (RA) are at increased risk for serious infections. Pneumococcal vaccination is among the most important preventive measures, however, vaccine uptake is suboptimal. We explored the rate and factors associated with pneumococcal vaccination in a contemporary RA cohort.

Materials and methods: Multi-center, prospective, RA cohort study in Greece. Patient and disease characteristics and influenza and pneumococcal vaccinations were documented at baseline and 3 years later.

Results: One thousand six hundred and ninety-seven patients were included and 34.5% had already received at least one pneumococcal vaccine at baseline. Among 1,111 non-vaccinated patients, 40.1% received pneumococcal vaccination during follow-up, increasing the vaccine coverage to 60.8%. By multivariate analysis, positive predictors for pneumococcal vaccination included prescription of influenza vaccine (OR = 33.35, 95% CI: 18.58-59.85), history of cancer (OR = 2.35, 95% CI: 1.09-5.06), bDMARD use (OR = 1.85, 95% CI: 1.29-2.65), seropositivity (OR = 1.47, 95% CI: 1.05-2.05), and high disease activity (DAS28-ESR, OR = 1.33, 95% CI: 1.17-1.51). Male sex (OR = 0.65, 95% CI: 0.43-0.99) was a negative predictor for pneumococcal vaccination during follow-up.

Discussion: Despite increasing rates of pneumococcal vaccine coverage, 40% of RA patients remain unvaccinated. Severe disease, bDMARD use, comorbidities, and more importantly flu vaccination were the most significant factors associated with pneumococcal vaccination, emphasizing the currently unmet need for cultivating a "vaccination culture" in RA patients.

Keywords: biological therapy; comorbidities; infections; rheumatoid arthritis; vaccination.

Copyright © 2023 Thomas, Lazarini, Kaltsonoudis, Voulgari, Drosos, Repa, Sali, Sidiropoulos, Tsatsani, Gazi, Fragkiadaki, Tektonidou, Sfikakis, Katsimbri, Boumpas, Argyriou, Boki, Karagianni, Katsiari, Evangelatos, Iliopoulos, Grika, Vlachoyiannopoulos, Dimitroulas, Garyfallos, Melissaropoulos, Georgiou, Georganas, Vounotrypidis, Ntelis, Areti, Kitas and Vassilopoulos.

Grants and funding

This work was partially supported by an unrestricted research grant from Pfizer, through the Special Account for Research Grants (SG) and National and Kapodistrian University of Athens, Athens, Greece (DV, Grant#12085). The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.