PCV13 Pneumonia Vaccine Shows Longer Durability Over PPV23 in People With COPD

PCV13 Streptococcus pneumoniae vaccinations had more persistent longer-term clinical efficacy than PPV23 vaccines, with a measurable difference in pneumonia episodes in older patients with chronic obstructive pulmonary disease (COPD).1

“Vaccines of 2 types are currently used to prevent pneumococcal infections: 13-valent conjugate vaccine and 23-valent polysaccharide vaccine.2 The question regarding the effectiveness and the personalized approach to vaccine selection is rather relevant. On one hand, the 23-valent vaccine with a wide range of serotypes allows one to broaden its spectrum of activity, especially in the regions endemic for these serotypes. On the other hand, the immune responses induced by polyvalent and conjugate vaccines differ fundamentally. Conjugate vaccines proved to have a prolonged effect and persistent clinical effectiveness in all age groups,” lead investigator Galina L Ignatova, Department of Therapy, South Ural State Medical University, Chelyabinsk, Russia, and colleagues wrote.1 “Furthermore, the long-term effect of using polyvalent vaccines (especially for immunocompromised patients) and the sequelae for the immune system have been insufficiently studied.”

Ignatova and colleagues conducted an open-label, prospective, observational cohort study including 302 male participants aged at least 45 years that received PCV13 (n = 123); PPV23 (n = 32); or no vaccine (n = 147). The study primarily assessed the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period, and secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and 6-min walk test.1

The investigators found that vaccination with PCV13 and PPV23 significantly reduced the total rate of pneumonia during the first year after vaccination, with the percentage of patients having at least 1 pneumonia episode reduced to 4.9% in the PCV13 group and to 6.3% in the PPV23 group compared with 15% in the vaccine-naïve patients (P = .024 and P = .707, respectively). However, during the second year, patients in the PPV23 group had significantly higher rates of pneumonia compared to those in the vaccine-naïve group, and, by year 5, reached a pneumonia rate of 47% as compared with 3.3% in the PCV13 group (P <.001) and 23.1% in the vaccine-naïve group (P = .027). By year 5, COPD exacerbations occurred in 81.3% of the PPV23 group and 23.6% of the PCV13 group (P <.001).1

After initial decreases, the PPV23 group had a median BODE score of 5 (IQR, 4-5) at 5 years, matching the vaccine-naïve group (IQR, 4-6) while the PCV13 group had a median BODE score remain low at a score of 3 (IQR, 2-3; P <.0001) at 5 years.1

Further analyses also found that PCV13 was effective in reducing pneumonia frequency regardless of age of FEV1 at the time of vaccination but PPV23 was only effective for patients under the age of 55 years with a limited duration of effect.

An analysis of the risk model showed that regardless of the age of the patient or FEV1 at the moment of vaccination, PCV13 could significantly reduce the frequency of pneumonia or completely prevent it in more than 95% of patients for up to a 5 year period. At the same time, the use of PPV23 is effective only for patients younger than 55 years and has a limitation on the duration of the effect.

“Administration of any pneumococcal vaccine reduced the exacerbation rate over 4-fold during the first year. Hence, pneumococcal vaccination has a positive effect on the course of COPD, which includes reduced exacerbation rate and improved overall quality of life. However, reduced hospitalization rates were stably observed only for PCV13, while the exacerbation rate and the rate of exacerbation-related hospitalizations increased abruptly as early as 2 years after vaccination with PPV23,” Ignatova and colleagues wrote.1

The investigators stated that larger and longer trials could further corroborate these findings and other effects of PCV13 vs PPV23 vaccinations.

REFERENCES

1. Ignatova GL, Avdeev SN, Antonov VN. Comparative effectiveness of pneumococcal vaccination with PPV23 and PCV13 in COPD patients over a 5-year follow-up cohort study. Sci Rep. 2021;11(1):15948. Published 2021 Aug 5. doi:10.1038/s41598-021-95129-w

2. Alvar, A., Decramer, M., Frith, P. Global initiative for chronic obstructive lung disease. Pocket guide to COPD diagnosis, management and prevention. Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf (2017).