Pneumococcal Vaccination in Patients With Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD) will be assessed for immunologic response to pneumococcal vaccination. Patients with IBD meet criteria as outlined by the Centers for Disease Control (CDC) for pneumococcal vaccination, yet the investigators have found that pneumococcal vaccination in this population is under-utilized. It is unknown whether or not IBD or IBD-related medications impact the immune response to this recommended vaccine.

Three groups of 25 patients each will be recruited. The first group will consist of outpatients with IBD who are receiving infliximab (Remicade TM) while on concommitant immunosuppressive therapy (with either 6MP, azathioprine, or methotrexate). This group is intended to represent a common 'heavily immunosuppressed' patient group with IBD.

The second group will consist of patients with IBD seen in our outpatient clinic who are not on any immune-suppressive medications. These patients meet CDC criteria for vaccination by virtue of having a chronic medical illness. The third group will consist of healthy age-matched (to the first group) controls.

After obtaining informed consent, patients will be screened with baseline lab tests including testing for antibodies against pneumococcus. At the baseline visit, patients will also undergo a brief medical history, physical examination, and assessment of their IBD disease activity.

Included patients will then undergo a one-time intramuscular vaccination with 23-valent polysaccharide pneumococcal vaccine (Pneumovax TM). One month later, subjects will return for a blood draw to assess for response to pneumococcal vaccination.

Study Overview

• Status: Completed
• Conditions: Crohn Disease; Ulcerative Colitis; Inflammatory Bowel Disease
• Intervention / Treatment: Biological: 23-valent polysaccharide pneumococcal vaccine (Pneumovax TM)

• Study Type: Interventional
• Enrollment (Actual): 69
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90048
      • Cedars-Sinai Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Males and females over the age of 18 with inflammatory bowel disease; healthy controls will be age- and sex-matched.
2. The patient must understand and voluntarily sign and informed consent document
3. A history of chronic (greater than 1 month) ulcerative colitis or Crohn's disease diagnosed and documented by the standard clinical, radiographic, endoscopic, and histopathologic criteria
4. (Group 1): Outpatients at CSMC IBD center with IBD who are on maintenance anti-TNF therapy with infliximab OR ADALIMUMAB plus concomitant immunomodulator therapy (with either 6MP, AZA, or MTX)
5. (Group 2): Outpatients at CSMC's IBD Center with documented IBD who are not on any immune-suppressive medications. Treatment with oral or topical 5-ASA products, antibiotics, or probiotics, are permitted.
6. (Group 3): Healthy volunteers without chronic illness, not on immune-suppressive medications.

Exclusion Criteria:

1. Hypersensitivity to any component of the vaccine
2. Current signs or symptoms of severe, progressive or uncontrolled renal, hepatic, hematologic, endocrine (including thyroid), pulmonary, cardiac, infectious, neurologic or cerebral disease. Included are ongoing chronic active conditions such as chronic active hepatitis.
3. Patients who in the judgment of the investigator are unwilling or unable to comply with all the protocol-related assessments and procedures.
4. History of alcohol or other drug abuse within one year, or any conditions associated with poor compliance.
5. Patients in whom venipunctures are not feasible due to poor tolerability or lack of easy access.
6. Healthy volunteers or patients with a history of prior pneumococcal vaccination
7. Any condition which, in the opinion of the Investigator, places the patient at unacceptable risk if he/she were to participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; IBD, on both an anti-TNF agent and an immunomodulator	Biological: 23-valent polysaccharide pneumococcal vaccine (Pneumovax TM); 0.5mL intramuscular, one time; Other Names: Pneumovax
Experimental: 2; IBD, not on any immunosuppressive medications	Biological: 23-valent polysaccharide pneumococcal vaccine (Pneumovax TM); 0.5mL intramuscular, one time; Other Names: Pneumovax
Active Comparator: 3; Healthy, non-IBD, not on immunosuppressive medications (control arm)	Biological: 23-valent polysaccharide pneumococcal vaccine (Pneumovax TM); 0.5mL intramuscular, one time; Other Names: Pneumovax

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Response, defined by postvaccination antibody titers	1 month

Collaborators and Investigators

• Sponsor: Cedars-Sinai Medical Center
• Investigators: Principal Investigator: Eric A Vasiliauskas, MD, Cedars-Sinai Medical Center

Study record dates

Study Major Dates

• Study Start: May 1, 2005
• Primary Completion (Actual): December 1, 2007
• Study Completion (Actual): December 1, 2007

Study Registration Dates

• First Submitted: January 23, 2009
• First Submitted That Met QC Criteria: January 26, 2009
• First Posted (Estimate): January 27, 2009

Study Record Updates

• Last Update Posted (Estimate): January 27, 2009
• Last Update Submitted That Met QC Criteria: January 26, 2009
• Last Verified: January 1, 2009

More Information

Terms related to this study

• Keywords: immunosuppression; ulcerative colitis; Crohn disease; inflammatory bowel disease; pneumococcal vaccine; pneumovax; anti tumor necrosis alpha
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Gastrointestinal Diseases; Gastroenteritis; Colonic Diseases; Ulcer; Inflammatory Bowel Diseases; Crohn Disease; Intestinal Diseases; Colitis; Colitis, Ulcerative; Physiological Effects of Drugs; Immunologic Factors; Heptavalent Pneumococcal Conjugate Vaccine
• Other Study ID Numbers: 6355