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T-cell-mediated immune response to pneumococcal conjugate vaccine (PCV-13) and tetanus toxoid vaccine in patients with moderate-to-severe psoriasis during tofacitinib treatment

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Winthrop KL1, Korman N2, Abramovits W3, Rottinghaus ST4, Tan H4, Gardner A5, Mukwaya G6, Kaur M7, Valdez H6. J Am Acad Dermatol. 2018 Mar 1. pii: S0190-9622(17)32583-5. doi: 10.1016/j.jaad.2017.09.076. [Epub ahead of print]

Abstract

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1 Oregon Health and Science University, Portland, Oregon. Electronic address: winthrop@ohsu.edu.

2 University Hospitals Case Medical Center, Cleveland, Ohio.

3 Dermatology Treatment and Research Center, Dallas, Texas.

4 Pfizer Inc, Groton, Connecticut.

5 Pfizer Inc, Cambridge, Massachusetts.

6 Pfizer Inc, New York, New York.

7 Pfizer Inc, Collegeville, Pennsylvania.

Abstract

BACKGROUND: Psoriasis is often treated with immunomodulatory therapies that can affect the immune response to common antigens. Tofacitinib is an oral Janus kinase inhibitor.

OBJECTIVE: To characterize the effect of long-term exposure to tofacitinib 10 mg twice daily on T-cell function in psoriasis patients.

METHODS: Patients completing at least 3 months' continuous treatment with tofacitinib 10 mg twice daily were vaccinated with T-cell-dependent vaccines (monovalent tetanus toxoid and 13-valent pneumococcal conjugate [PCV-13]). Patients were assessed at baseline (before vaccination) and then again 4 weeks after vaccination. For PCV-13, we evaluated serotype-specific, opsonophagocytic antibody responses, and for tetanus toxoid, we evaluated humoral responses.

RESULTS: Among 60 patients who completed the study, the geometric mean fold rise from baseline for the 13 PCV serotypes at 4 weeks postvaccination varied from 8.3 (serotype 3) to 101.9 (serotype 6A). Similar results were observed for patients with and without lymphopenia at baseline. For tetanus toxoid, 51 (88%) patients had ≥2-fold and 35 (60%) patients had ≥4-fold rise in antibody concentration.

LIMITATIONS: There was no placebo control.

CONCLUSION: Most psoriasis patients who receive tofacitinib can mount satisfactory T-cell-dependent responses to PCV-13 and tetanus vaccines.