gms | German Medical Science

46. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 32. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

19.09. - 22.09.2018, Mannheim

Pneumococcal vaccination rates in patients with rheumatoid arthritis treated with immunosuppressants in Germany

Meeting Abstract

  • Julia Schiffner-Rohe - Pfizer Deutschland GmbH, Health&Value, Health Technology Assessment & Outcomes Research (HTA&OR), Berlin
  • Niklas Schmedt - InGef – Institute for Applied Health Research Berlin, Berlin
  • Nils Kossack - Wig2 GmbH, Leipzig
  • Ralf Sprenger - Pfizer Pharma GmbH, Vaccines, Medical, Berlin
  • Jochen Walker - Health Risk Institute GmbH, Berlin
  • Dennis Häckl - Wig2 GmbH, Leipzig
  • Christof von Eiff - Pfizer Pharma GmbH, Vaccines, Medical, Berlin

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 46. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 32. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Mannheim, 19.-22.09.2018. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocEV.06

doi: 10.3205/18dgrh055, urn:nbn:de:0183-18dgrh0551

Veröffentlicht: 5. Februar 2019

© 2019 Schiffner-Rohe et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background: Patients with rheumatoid arthritis (RA) have an up to 2.7 fold risk of developing pneumonia in comparison to healthy adults. To account for this, the German Committee on Vaccination (“Ständige Impfkommission”, STIKO) recommends a sequential pneumococcal (pnc)-vaccination scheme (conjugate vaccine followed by polysaccharide vaccine), in immuno-incompetent patients aged two years and older. Aim of this study was to assess vaccination rates in incident immuno-incompetent patients. Data on RA-patients with immunosuppressive treatment will be presented here.

Methods: We conducted a cohort study based on claims data on a sample of 4 million persons, representative of the German population with regard to the age and sex. The study cohort comprised patients with a first episode (“incident case”) of immune-incompetence according to STIKOin 2013 or 2014 (pick-up period) who were followed until the end of study period (Dec 2016), death or first documented pnc-vaccination. Underlying RA was identified according to ICD-10 GM codes M05.*, M06.*. Immunosuppressive use was identified according to ATC (code L04* and M01CX01 (methotrexate)). Data from 2011-2012 served to define incident cases and exclude prior pnc-vaccination. Pnc-vaccination rate was calculated as proportion of patients with pnc-vaccination within two years (post hoc analysis: three years) after index date with 95% confidence intervals. Vaccinating physician speciality was defined as physician administering first pnc-vaccine.

Results: The study cohort comprised 1,887 patients with RA initiating treatment with immunosuppressants. Pnc-vaccination rate within two years after start of treatment was 11.5% [10.1; 13.0] and did not increase relevantly looking at a longer time period of three years (12.3% [10.4; 14.5]). The large majority of patients with first episode of any immune-incompetence diagnosed by rheumatologists were vaccinated by a general practitioner (GP) with 75.9%; approx. 20% were vaccinated by a rheumatologist. High-risk patients diagnosed by rheumatologists were vaccinated 306 [269; 342] days post diagnosis in mean with 35.7% thereof vaccinated in the first 6 months.

Conclusion: Our study suggests that the overall pnc-vaccination rate in patients with RA initiating treatment with immunosuppressants is very low. To prevent pneumococcal diseases in this highly vulnerable population, further efforts to strengthen the awareness and improve collaboration between the vaccinating GP and specialized physician are needed.