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Arthritis, RheumatoidNCT01947465

Immunogenicity and Safety of Vaccinations in Immunocompromised Persons

An observational study of Arthritis, Rheumatoid and Spondylarthritis, run by University of Zurich at 10 sites in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Backgound and relevance of the project: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at increased risk of contracting infections. The increased risk can be attributed to the immunological disorder itself, as well as to the immunosuppressive treatment. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
What is being tested?
Hepatitis A vaccine and tetanus vaccine
Type of treatment
Vaccines
How many people
645 participants
Where
10 sitesSwitzerland
Study dates
Oct 2013to Feb 2016
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: The cohort will be selected from patients with rheumatic diseases under treatment at 6 rheumatology outpatient clinics in Switzerland (University of Basel, University of Bern, University of Geneva, University of Zurich, Cantonal Hospital Aarau, Cantonal Hospital St. Gallen)

Who may be able to join

  • Indication for hepatitis A and/or tetanus vaccination according to Swiss Federal Office of Public Health recommendations
  • Male and female rheumatic patients with rheumatoid arthritis or axial spondyloarthritis (ankylosing spondylitis, axial psoriatic arthritis, axial undifferentiated spondyloarthritis, enteropahtic arthritis) or peripheral psoriatic arthritis or vasculitis (Behçet's disease or ANCA-associated vasculitis) or male and female healthy participants ≥ 18 years
  • Signed Informed Consent after being informed

Who cannot join

  • Known hypersensitivity to a vaccine ingredient
  • Estimated patient survival below 1 year
  • Active malignant or active infectious disease
  • Drug/alcohol abuse
  • Insufficient understanding of local language

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

Switzerland10 sites
  • Cantonal Hospital Aarau, Division of Rheumatology

    Aarau, Canton of Aargau, 5001

  • University Hospital of Basel, Rheumatology Division

    Basel, Basel Town, 4031

  • Swiss Tropical and Public Health Institute

    Basel, Basel Town, 4051

  • University of Bern, Inselspital, Division of Infectious Diseases and Travel Medicine

    Bern, Canton of Bern, 3010

  • University of Bern, Inselspital, Division of Rheumatology

    Bern, Canton of Bern, 3010

  • University of Geneva, University Hospitals, Division of Rheumatology

    Geneva, Canton of Geneva, 1211

  • University of Geneva, University Hospitals, Service de Médecine Tropicale et Humanitaire

    Geneva, Canton of Geneva, 1211

  • Cantonal Hospital St. Gallen, Division of Rheumatology

    Sankt Gallen, Canton of St. Gallen, 9007

  • University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Divison of Infectious Diseases

    Zurich, Canton of Zurich, 8001

  • University of Zurich, University Hopsital, Divison of Rheumatology

    Zurich, Canton of Zurich, 8091

Other trials in Switzerland

About this study

Official title: A Prospective Cohort Study in 6 Swiss Rheumatology Centres and 4 Travel Clinics on the Immunogenicity and Safety of Tetanus and Hepatitis A Vaccine in Patients With Rheumatoid Arthritis, Axial Spondyloarthritis and Vasculitis and Healthy Controls

Backgound and relevance of the project:

Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at increased risk of contracting infections. The increased risk can be attributed to the immunological disorder itself, as well as to the immunosuppressive treatment. Vaccination against many infections is recommended in this patient group. However, the immunogenicity of vaccines may be reduced and may also be influenced by the administered treatment. Potential reactivation of the underlying disease triggered by vaccination is another important concern.

Read more

From the patients' and public health perspectives, an important task of physicians is giving advice on vaccines. Completing this task is often difficult, because data on the immunogenicity and safety of vaccines in these patient groups are scarce, especially with regard to treatment with new immunosuppressive medications, such as biological agents. Lastly and importantly, due to new therapeutic options, health among AIIRD patients has considerably improved and an increasing number of patients undertake overseas travel activities requiring additional vaccinations. In this context, reliable advice with regard to vaccinations is almost impossible, because for most travel vaccinations the immunogenicity and safety profile is unknown.

Research addressing the immunogenicity and safety of vaccines in different autoimmune inflammatory diseases treated with different immunosuppressive medications is urgently needed to allow giving evidence based vaccine advice.

In this observational study the immunogenicity and safety of tetanus booster and hepatitis A vaccinations will be assessed in AIIRD patients. The immune response will be evaluated as a function of the underlying disease and the possible influence of commonly used immunosuppressive drugs on the immune response will be studied.

Rationale for studying tetanus booster and hepatitis A vaccine Tetanus vaccination is one of the most frequently recommended vaccinations, and the effect of a booster vaccination can be addressed. Hepatitis A vaccine is the most widely used travel vaccine. Despite their importance, only very limited data are available for tetanus and hepatitis A vaccine in this patient group. By focusing on these vaccines the study will lead the way to the evaluation of further vaccines.

The purpose of this study is to determine whether tetanus and hepatitis A vaccinations are as immunogenic and safe in AIIRD patients as in healthy controls.

Read the detailed description

The study will be placed in 6 rheumatology clinics in Switzerland and in 4 travel medicine clinics. Consecutive subjects with rheumatoid arthritis, spondylarthritis (ankylosing spondylitis), vasculitis (ANCA associated vasculitis and Behçet's disease) and healthy controls will be recruited.

Being tested
Hepatitis A vaccine and tetanus vaccine
Medical subject headings
Arthritis, Rheumatoid, Spondylarthritis, Vasculitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hepatitis A vaccine and tetanus vaccineBiological

    Also called Havrix 1440, Epaxal, Td-Pur, Boostrix

    Hepatitis A and/or tetanus vaccination will be given to participants in all group on day 0. All monovalent active hepatitis A vaccinations and all vaccines containing tetanus toxoid available in Switzerland may be used in the study

Study groups in NCT01947465
Study groupRoleWhat they receive
Healthy controlsIf a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 319 healthy controls will be enrolled and will receive hepatitis A and/or tetanus vaccination
Receives: Biological: Hepatitis A vaccine and tetanus vaccine
Patients with rheumatoid arthritisIf a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 142 patients with rheumatoid arthritis will be enrolled and will receive hepatitis A and/or tetanus vaccination.
Receives: Biological: Hepatitis A vaccine and tetanus vaccine
Patients with axial spondylarthritisIf a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 142 patients with axial spondylarthritis will be enrolled and will receive hepatitis A and/or tetanus vaccination.
Receives: Biological: Hepatitis A vaccine and tetanus vaccine
Patients with vasculitisIf a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 142 patients with vasculitis will be enrolled and will receive hepatitis A and/or tetanus vaccination.
Receives: Biological: Hepatitis A vaccine and tetanus vaccine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Immunogenicity of hepatitis A and tetanus vaccination in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls

    comparison of the geometric mean antibody titre and percentage of seroprotected individuals after tetanus and hepatitis A vaccination between each disease group and healthy controls

    Measured: Change from Baseline in geometric mean antibody titre and seroprotection at 4 weeks and at 12 weeks

Secondary outcomes (1)
  1. Safety of tetanus and hepatitis A vaccines in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls

    Number of patients with any worsening or reactivation of the rheumatic disease after vaccine administration

    Number of participants with adverse vaccine reactions (local and systemic reactions) in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls

    Measured: Activation of rheumatic disease will be assessed for 1 week after vaccine administration and at 4 and 12 weeks compared to baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Sep 2013 (estimated)
  2. Study startOct 2013
  3. Primary completionDec 2015
  4. Study completionFeb 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
645 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01947465
Sponsor's protocol ID
CS_2013_01
Status last verified
Feb 2016
First submitted
22 Aug 2013
Last updated
25 Feb 2016
Results posted
No
Data monitoring committee
No

Publications

  • van Assen S, Elkayam O, Agmon-Levin N, Cervera R, Doran MF, Dougados M, Emery P, Geborek P, Ioannidis JP, Jayne DR, Kallenberg CG, Muller-Ladner U, Shoenfeld Y, Stojanovich L, Valesini G, Wulffraat NM, Bijl M. Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases. Autoimmun Rev. 2011 Apr;10(6):341-52. doi: 10.1016/j.autrev.2010.12.003. Epub 2010 Dec 20.

    PubMed 21182987
  • Bijl M, Kallenberg CG, van Assen S. Vaccination of the immune-compromised patients with focus on patients with autoimmune-inflammatory diseases. Neth J Med. 2011 Jan;69(1):5-13.

    PubMed 21325695
  • Doran MF, Crowson CS, Pond GR, O'Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002 Sep;46(9):2287-93. doi: 10.1002/art.10524.

    PubMed 12355475
  • Bernatsky S, Hudson M, Suissa S. Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford). 2007 Jul;46(7):1157-60. doi: 10.1093/rheumatology/kem076. Epub 2007 May 3.

    PubMed 17478469
  • Kotton CN. Vaccination and immunization against travel-related diseases in immunocompromised hosts. Expert Rev Vaccines. 2008 Jul;7(5):663-72. doi: 10.1586/14760584.7.5.663.

    PubMed 18564020
  • Rahier JF, Moutschen M, Van Gompel A, Van Ranst M, Louis E, Segaert S, Masson P, De Keyser F. Vaccinations in patients with immune-mediated inflammatory diseases. Rheumatology (Oxford). 2010 Oct;49(10):1815-27. doi: 10.1093/rheumatology/keq183. Epub 2010 Jun 29.

    PubMed 20591834
  • Steffen R, Kane MA, Shapiro CN, Billo N, Schoellhorn KJ, van Damme P. Epidemiology and prevention of hepatitis A in travelers. JAMA. 1994 Sep 21;272(11):885-9.

    PubMed 8078167
  • Agarwal N, Ollington K, Kaneshiro M, Frenck R, Melmed GY. Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review. Vaccine. 2012 Feb 14;30(8):1413-24. doi: 10.1016/j.vaccine.2011.11.109. Epub 2011 Dec 21.

    PubMed 22197580
  • Buhler S, Jaeger VK, Adler S, Bannert B, Brummerhoff C, Ciurea A, Distler O, Franz J, Gabay C, Hagenbuch N, Herzog C, Hasler P, Kling K, Kyburz D, Muller R, Nissen MJ, Siegrist CA, Villiger PM, Walker UA, Hatz C. Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases-a prospective multi-centre cohort study. Rheumatology (Oxford). 2019 Sep 1;58(9):1585-1596. doi: 10.1093/rheumatology/kez045.

    PubMed 30877773

Questions about this trial

What is this clinical trial studying?

An observational study of Arthritis, Rheumatoid and Spondylarthritis, run by University of Zurich at 10 sites in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Feb 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Immunogenicity of hepatitis A and tetanus vaccination in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls (time frame: Change from Baseline in geometric mean antibody titre and seroprotection at 4 weeks and at 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01947465, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Feb 2016.

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