How Can Lupus Patients Be Vaccinated Safely And Effectively When Using Biologics?

In recent years, immunosuppressants have improved the prognosis and outcome of patients with autoimmune inflammatory rheumatic diseases under the target treatment and early treatment strategies. However, infectious complications due to drug-related side effects have become an important issue in clinical practice. In terms of infection, vaccination is crucial to reduce infection morbidity and mortality in patients with systemic lupus erythematosus (SLE). However, there is currently no authoritative guideline/consensus on vaccination strategies for SLE patients.

Click to cistanche herba for kidney disease

On June 19th, Ann Rheum Dis. (impact factor 27.4), an authoritative journal in the field of rheumatology, published an article. Professor David Alan Isenberg, University of London School of Medicine, UK, and his collaborators reviewed the latest data in the field of vaccination of SLE patients, focusing on biological agents (especially rituximab and belimumab), and made vaccination recommendations involving a variety of routine vaccines such as a pneumococcal vaccine, influenza vaccine, and shingles vaccine.

1. Pneumococcal vaccine

According to the EULAR recommendation, all patients with rheumatic diseases receiving disease-modifying antirheumatic drugs (DMARDs) should be vaccinated against pneumococcus. For rituximab, it is recommended to vaccinate before the dose, or with as long an interval as possible after the last dose (ideally interval ≥ 6 months), and to vaccinate 4 weeks before the next dose.

For belimumab, there are no authoritative recommendations to guide pneumococcal vaccination. Based on existing research, scholars suggest that those who use belimumab can refer to the principles of pneumococcal vaccination in the general population.

2. Influenza vaccine

Compared with healthy people, the seroprotection rate or seroconversion rate of SLE patients after inactivated influenza vaccine is lower, but it can still provide some protection. Therefore, it is recommended that all SLE patients receive inactivated influenza vaccine every year.

In the 2019 EULAR recommendations on vaccination, ideally, influenza vaccine should be given before starting rituximab or revaccinated at a longer interval after the last dose, and 2-4 days before the next dose. weekly inoculation.

Similar to the pneumococcal vaccine situation, there is no authoritative recommendation to guide the influenza vaccination strategy when belimumab is administered. Scholars suggest that this group of people can refer to the principles of influenza vaccination for the general population.

3. Tetanus vaccine

Based on limited data and EULAR recommendations, patients with SLE should be vaccinated against tetanus before initiating rituximab if indicated. For patients receiving belimumab treatment, based on existing data, it is recommended to routinely receive a tetanus vaccine by the principles of the general population.

4. Shingles Vaccine

Currently, EULAR recommends that high-risk patients be vaccinated against shingles, while ACR guidelines recommend that all patients with rheumatic diseases over the age of 18 be vaccinated against shingles.

In the course of SLE treatment, for rituximab, it is recommended to receive herpes zoster vaccine before the dose, or after the last dose as long as possible (ideally interval ≥ 6 months), and before the next dose Vaccination within 4 weeks; there is no research support for belimumab, and the benefits and risks of vaccination should be carefully evaluated, especially for patients with high risk of herpes zoster infection.

5. Other inactivated vaccines

There are currently insufficient data to assess the impact of biologics on the efficacy of other inactivated vaccines. Rituximab treatment is known to lead to HBV reactivation, but its effect on HBV vaccine response in SLE patients is unknown. According to the ACR guidelines on vaccination, it is recommended to postpone vaccination during the administration of rituximab, to receive the vaccine before the next dose, and to postpone the administration for at least 2 weeks after vaccination.

Vaccination is the cornerstone of preventive medicine. There is a clear benefit of vaccination in SLE patients, however, in this era of biologics, further studies are needed to monitor the efficacy of vaccines in SLE patients, especially the interaction with immunosuppressants. Therefore, after recognizing this effect, clinicians should carefully evaluate vaccine indications and inform patients of the risks, benefits, and precautions of vaccination to achieve better vaccination effects.

How does Cistanche treat kidney disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.

References:

 Yıldırım R, Oliveira T, Isenberg DA. Approach to vaccination in systemic lupus erythematosus on biological treatment. Ann Rheum Dis. 2023 Jun 19:ard-2023-224071. doi: 10.1136/ard-2023-224071. Epub ahead of print. PMID: 37336639.