What is immunology?

From the Guidelines

Immunocompromised individuals should be vaccinated with inactivated vaccines, as they are at increased risk for morbidity and mortality from various infections, and live vaccines may pose a risk of serious consequences or inadequate response. When considering vaccination for immunocompromised individuals, it is essential to weigh the risks and benefits, taking into account the specific immunodeficiency and the type of vaccine.

• Primary immunodeficiencies, such as B lymphocyte (humoral) deficiencies, may require caution with live vaccines, such as oral poliovirus vaccine (OPV), smallpox, and live, attenuated influenza vaccine (LAIV) 1.
• Secondary immunodeficiencies, such as those caused by human immunodeficiency virus (HIV) infection, solid organ or hematopoietic malignancies, or transplantation, may also require special considerations for immunization 1.
• Inactivated vaccines, such as tetanus and reduced diphtheria toxoids (Td) and inactivated trivalent influenza vaccines, are generally recommended for immunocompromised individuals 1.
• The effectiveness of vaccines in immunocompromised individuals depends on the degree of immune suppression, and some vaccines may be ineffective in certain individuals 1.
• Recent studies have emphasized the importance of vaccinating immunocompromised individuals, as they are at increased risk for morbidity and mortality from vaccine-preventable diseases 1.
• The diagnosis and management of primary immunodeficiencies have been outlined in practice parameters, which provide guidance on the classification, diagnosis, and treatment of these disorders 1.
• Understanding the immune system and its responses to pathogens is crucial for developing effective vaccination strategies for immunocompromised individuals 1.

From the Research

Immunology Overview

• The immune system is composed of two lines of defense: the innate and adaptive immune systems 2
• The innate immune system provides a rapid response to infection or injury, while the adaptive immune system provides specific, long-lasting responses against particular infections 2
• Defects in immune function can lead to diseases such as autoimmune diseases and allergies 2

Rheumatoid Arthritis Treatment

• Methotrexate (MTX) is a commonly used disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA) 3
• Biologics, such as adalimumab, etanercept, and infliximab, have been shown to be effective in reducing symptoms and slowing radiographic joint damage in RA patients 4, 5, 6
• The combination of a biologic with MTX has been shown to be more effective than MTX alone in some cases 4, 5, 6
• However, the use of biologics is associated with an increased risk of serious adverse events, such as infections 5, 6

Biologic Treatment Comparison

• A network meta-analysis compared the efficacy of different biologics, including abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, tocilizumab, and tofacitinib, in RA patients who had an inadequate response to conventional DMARDs 4
• The results showed that most biologics had similar efficacy when used in combination with MTX, but tocilizumab had higher American College of Rheumatology (ACR) responses when used as monotherapy compared to other biologics 4
• Another study compared the effectiveness of adalimumab, etanercept, and infliximab in RA patients and found that all three biologics were effective in reducing symptoms and slowing radiographic joint damage, but had different cost-effectiveness ratios 6

Cost-Effectiveness of Biologics

• The cost-effectiveness of biologics in the treatment of RA has been evaluated in several studies, with results showing that biologics can be cost-effective in certain scenarios, such as when used as third-line therapy 6
• However, the cost-effectiveness of biologics can vary depending on factors such as the specific biologic used, the patient population, and the treatment regimen 6
• Further research is needed to fully understand the cost-effectiveness of biologics in the treatment of RA and to determine the most effective and cost-effective treatment strategies 6