减毒带状疱疹活疫苗对系统性红斑狼疮患者的长期免疫原性

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2025-06-05 DOI:10.1016/j.vaccine.2025.127365

Chi Chiu Mok, Kar Li Chan, Sau Mei Tse

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引用次数: 0

摘要

目的研究带状疱疹减毒活疫苗对系统性红斑狼疮（SLE）的5年免疫原性。方法：本研究是一项扩展观察性研究，研究HZ活疫苗（Zostavax）对参加安慰剂（PBO）对照随机对照试验（RCT）的成年稳定SLE （SLEDAI <；6和免疫抑制治疗≥6个月）患者的免疫原性。重新评估5年后体液（抗vzv IgG反应性）和细胞介导（vzv刺激的IFN-γ酶联ELISPOT测定）对HZ的反应。在最初的RCT的90例患者中，70例患者同意这项研究(32例接受疫苗治疗；PBO组38例；年龄51.9±15.5 vs 50.0±13.2；p = 0.59；91% vs 97%的女性；p = 0.33)。从第6周到第5年，疫苗组抗vzv IgG反应性变化为- 14.5% (p = 0.06)， PBO组为- 10.1% （p = 0.02）。在调整基线值后，接种疫苗的5年抗vzv IgG反应性显著高于接受pbo治疗的患者(3.61±1.56 vs 2.94±1.03；p = 0.01)。接种疫苗的患者分泌IFN-γ的t细胞斑点数量（每5 × 105个细胞）增加(+ 65.5%；p = 0.23)，但pbo治疗的患者在第6周至第5年下降(- 5.3%；p = 0.83)。经基线值调整后，疫苗组患者第5年的t细胞斑点数高于PBO组患者(58.1±71.5 vs 24.9±23.2；p = 0.06)。t细胞斑点数量减少≥20%的患者比例在疫苗组（30.8%）显著低于PBO组（61.1%）（p = 0.046）。在接种疫苗的患者中，在t细胞或体液HZ反应降低≥20%的患者中，观察到累积泼尼松龙增加的趋势，非糖皮质激素免疫抑制药物的新添加或剂量增加的趋势。1名接种疫苗的患者（3.1%）和3名pbo治疗的患者（7.9%）经历了HZ再激活，但差异无统计学意义（p = 0.62）。结论安定型SLE患者5年免疫原性基本保持。

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Long-term immunogenicity of a live attenuated herpes zoster vaccine in patients with systemic lupus erythematosus

Objectives

To study the 5-year immunogenicity of a live attenuated herpes zoster (HZ) vaccine in systemic lupus erythematosus (SLE).

Method

This is an extended observational study of the immunogenicity of a live HZ vaccine (Zostavax) in adult patients with stable SLE (SLEDAI <6 and immunosuppressive treatment for ≥6 months) who participated in a placebo (PBO)-controlled randomized controlled trial (RCT). Humoral (anti-VZV IgG reactivity) and cell-mediated (VZV-stimulated IFN-γ enzyme-linked ELISPOT assay) responses to HZ at 5 years were reassessed.

Results

Of the 90 patients in the original RCT, 70 patients consented for this study (32 treated with vaccine; 38 treated with PBO; age 51.9 ± 15.5 vs 50.0 ± 13.2 years; p = 0.59; 91 % vs 97 % women; p = 0.33). The change in anti-VZV IgG reactivity from week 6 to year 5 was −14.5 % (p = 0.06) in the vaccine and − 10.1 % (p = 0.02) in the PBO group, respectively. The anti-VZV IgG reactivity at year 5 was significantly higher in vaccinated than PBO-treated patients, after adjustment for baseline values (3.61 ± 1.56 vs 2.94 ± 1.03; p = 0.01). The number of IFN-γ secreting T-cell spots (per 5 × 10⁵ cells) increased in vaccinated patients (+65.5 %; p = 0.23) from week 6 to year 5 but decreased in PBO-treated patients (−5.3 %; p = 0.83). The T-cell spots number at year 5 was higher in vaccine than PBO treated patients after adjustment for baseline values (58.1 ± 71.5 vs 24.9 ± 23.2; p = 0.06). The proportion of patients who had a reduction in T-cell spots number by ≥20 % was significantly lower in the vaccine (30.8 %) than PBO (61.1 %) groups (p = 0.046). Among vaccinated patients, a trend of higher cumulative prednisolone, more new addition or dosage increase of non-glucocorticoid immunosuppressive drugs was observed in those who had reduction in T-cell or humoral HZ responses by ≥20 %. One vaccinated patient (3.1 %) and three PBO-treated patients (7.9 %) experienced HZ reactivation, but the difference was not significant (p = 0.62).

Conclusions

Immunogenicity of Zostavax in stable SLE patients is largely retained at 5 years.

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

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