Immunogenity of the pneumococcal polysaccharide vaccine in COPD patients. The effect of systemic steroids

Rationale: To investigate if systemic steroids influence the antibody response to the 23-valent pneumococcal polysaccaride vaccine (23-PPV) in COPD patients. Patients and methods: COPD patients on: (a) greater than or equal to 10 mg of prednisolone/day (SS, n = 30); (b) inhalative steroids (IS, n = 30); (c) controls without COPD (CG, n = 29) were vaccinated with 23-PPV. The concentration (mug/ml) of capsular specific anti-pneumococcal IgG antibodies (AB) for the serotypes (PNC) 4,6B,9V,14,18C,19F,23F were measured by Elisa technique before, 3 and 12 months (m) after vaccination. Non-responders were defined when AB-concentrations did neither doubled nor reach greater than or equal to 1 mug/ml. Results: N = 24 (CG), n = 29 (IS), n = 18 (SS) patients completed the study (mean age 64yrs.). Serious adverse events were not observed. Geometric mean (GM) AB-concentration of all serotypes increased significantly (CG, IS, SS) 3 and 12 m after vaccination (P < 0.05). The percentage of non-responders ranged between 16% (PNC 19F, IS) and 65% (PNC 4, SS) after 3 m and 21% (PNC 19F, IS) and 82% (PNC 4, CG) after 12 m. Neither post-vaccine AB-concentrations (3 and 12 m) nor the rate of non-responders differed significantly between patients on systemic steroids and the other groups (IS, CG). Conclusions: Systemic steroids did not influence the AB-response. In all groups mean AB-concentration increased significantly after vaccination but an important percentage of subjects of all three groups were non-responders. (C) 2004 Elsevier Ltd. All rights reserved.