jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2024-16-3-36-44jofin-1660Research ArticleОбзорыReviewИммуногенность полисахаридной пневмококковой вакцины у больных ревматоидным артритомImmunogenicity of Pneumococcal Polysaccharide Vaccine in patients with rheumatoid arthritisБатожаргаловаБ. Ц.BatozhargalovaB. Ts.

Батожаргалова Баирма Цыдендамбаевна – ведущий научный сотрудник лаборатории вакцинопрофилактики и иммунотерапии аллергических заболеваний, д.м.н.

тел.: +7-915-319-07-22 

Москва 

 Moscow 

bairma74@mail.ruСагатбаеваН. А.SagatbayevaN. A.

Сагатбаева Нургуль Абаевна – заведующий кафедрой пропедевтики детских болезней, к.м.н.

тел.: +7(701)500-04-25 

Алматы 

 Almaty 

sagatbaeva.n@kaznmu.kzАбдуллаеваГ. М.AbdullayevaG. M.

Абдуллаева Гульбан Махаметжановна – доцент кафедры пропедевтики детских болезней, к.м.н.

тел.: +7(701)411-79-41 

Алматы

 Almaty 

abdullaeva.g@kaznmu.kzБытырхановШ. К.BytyrkhanovSh. K.

Батырханов Шайхслам Килибаевич – профессор кафедры пропедевтики детских болезней, д.м.н.

Алматы

 Almaty 

batyrhanov.sh@kaznmu.kzСоловьеваИ. Л.SolovеvaI. L.

Соловьева Ирина Леонидовна – заведующий кафедрой педиатрии Ульяновского государственногоуниверситета, д.м.н., профессор

тел.: +7-951-096-73-23 

Ульяновск

Ulyanovsk 

irsol126@mail.ruКостиновМ. П.KostinovM. P.

Костинов Михаил Петрович – заведующий лабораторией вакцинопрофилактики и иммунотерапии аллергических заболеваний; заведующий кафедрой эпидемиологии и современных технологий вакцинации, д.м.н.,профессор, член-корреспондент РАН

тел.: +7-963-782-35-23 

Москва 

 Moscow 

monolit.96@mail.ruШмитькоА. Д.ShmitkoA. D.

Шмитько Анна Дмитриевна – старший научный сотрудник лаборатории вакцинопрофилактикии иммунотерапии аллергических заболеваний, к.м.н.

тел.: +7-926-374-45-25 

Москва 

 Moscow 

violadellanna@gmail.comНаучно-исследовательский институт вакцин и сывороток им. И.И. МечниковаРоссияResearch Institute of Vaccines and Sera named after I.I. MechnikovRussian FederationКазахский национальный медицинский университет им С.Д. АсфендияроваКазахстанKazakh National Medical University named after S.D. AsfendivarovKazakhstanУльяновский государственный университетРоссияUlyanovsk State UniversityRussian FederationНаучно-исследовательский институт вакцин и сывороток им. И.И. Мечникова; Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияResearch Institute of Vaccines and Sera named after I.I. Mechnikov; First Moscow State Medical University named after I.M. Sechenov (Sechenov University)Russian Federation2024210920241633644Copyright © Батожаргалова Б.Ц., Сагатбаева Н.А., Абдуллаева Г.М., Бытырханов Ш.К., Соловьева И.Л., Костинов М.П., Шмитько А.Д., 20242024Батожаргалова Б.Ц., Сагатбаева Н.А., Абдуллаева Г.М., Бытырханов Ш.К., Соловьева И.Л., Костинов М.П., Шмитько А.Д.Batozhargalova B.T., Sagatbayeva N.A., Abdullayeva G.M., Bytyrkhanov S.K., Solovеva I.L., Kostinov M.P., Shmitko A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1660

В представленном обзоре проведен поиск статей в базах данных PubMed, Web of Science, Scopus, Google Scholar, eLibrary (2002–2022 гг.) и дана оценка иммуногенности 23-валетной полисахаридной пневмококковой вакцины у взрослых больных ревматоидным артритом, получающих различные противоревматические препараты.Результаты данного обзора свидетельствуют о достаточной иммуногенности 23-валетной полисахаридной пневмококковой вакцины у больных ревматоидным артритом, находящихся на монотерапии различными генно-инженерными биологическими препаратами (иФНОα, ингибиторами рецептора ИЛ-6, блокаторами костимуляции Т-лимфоцитов), таргетными синтетическими базисными противовоспалительными, а также глюкокортикоидами в средних и низких дозах. Монотерапия метотрексатом, ритуксимабом и комбинированная терапия генно-инженерными биологическими препаратами и монотерапией метотрексатом, а также таргетными синтетическими базисными противовоспалительными препаратами и монотерапией метотрексатом у больных ревматоидным артритом снижали поствакцинальный пневмококковый ответ. АнтиIgG антитела, вырабатываемые в ответ на введение 23-валетной полисахаридной пневмококковой вакцины, обладали функциональной активностью даже у тех пациентов с ревматоидным артритом, у которых антитела не определялись в достаточных защитных значениях на терапии генно-инженерными биологическими препаратами, или были снижены у пациентов, получающих монатерапию метотрескатом. Сделано заключение о возможности формирования антител к пневмококку у больных ревматоидным артритом на терапии базисными противовоспалительными, таргетными синтетическими базисными противовоспалительными препаратами и генно-инженерными биологическими препаратами. В связи с возможностью формирования низкого уровня антител на фоне лечения ритуксимабом необходимо рекомендовать проведение вакцинации против пневмококковой инфекции до начала терапии.

The presented review searched for articles in the databases PubMed, Web of Science, Scopus, Google Scholar, eLibrary (2002-2022) and assessed the immunogenicity of the 23-valent polysaccharide pneumococcal vaccine (PPV23) in adult patients with rheumatoid arthritis (RA), receiving various antirheumatic drugs. The results of this review indicated sufficient immunogenicity of PPV23 in RA patients receiving monotherapy with various biological drugs (bDMARDs) (TNFα inhibitors, IL6 receptor inhibitors, T-lymphocyte costimulation blockers), targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), and glucocorticoids (GC) in medium and low doses. Monotherapy with methotrexate (MTX), rituximab and combination therapy with bDMARDs +MTX, tsDMARDs+MTX in RA patients reduced the postvaccination pneumococcal response. IgG AT generated in response to PPV23 injection shown functional activity even in RA patients whose antibodies were either lowered in patients receiving MTX or were not detectable at protective values following bDMARD therapy. The potential for pneumococcus antibody production in RA patients receiving therapy with disease-modifying antirheumatic drugs (DMARDs), tsDMARDs and bDMARDs, was concluded. Vaccination against pneumococcal infection should be advised prior to starting therapy due to the likelihood of low antibody levels developing during rituximab treatment.

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The authors declare that there are no conflicts of interest present.