Vaccination strategies for patients under monoclonal antibody and other biological treatments: an updated comprehensive review based on EMA authorisations to January 2024.

INTRODUCTION: Monoclonal antibodies (mAbs) and other biological agents are being increasingly approved in the last years with very different indications. Their highly heterogeneous immunosuppressive effects, mechanisms of action and pharmacokinetics require comprehensive individualized vaccination schedules. AREAS COVERED: Vaccination for immunocompromised patients. Prevention and treatment with mAbs and other biological therapies. EXPERT OPINION: Current recommendations on vaccine schedules for patients under mAbs or other biological treatments are based on expert opinions and are not individualized according to each vaccine and treatment. No studies are focusing on the high heterogeneity of these agents, which are exponentially developed and used for many different indications. Recent paradigm changes in vaccine development (boosted by the COVID-19 pandemic) and in the mAbs use for prophylactic purposes (changing 'vaccination' by 'immunization' schedules) has been witnessed in the last years. We aimed at collecting all mAbs used for treatment or prevention, approved as of 1 January 2024, by the EMA. Based on available data on mAbs and vaccines, we propose a comprehensive guide for personalizing vaccination. Recent vaccine developments and current population strategies (e.g. zoster vaccination or prophylactic nirsevimab) are discussed. This review aims to be a practical guideline for professionals working in vaccine consultations for immunosuppressed patients.

Vaccination in patients under monoclonal antibody treatment: an updated comprehensive review.

INTRODUCTION: Monoclonal antibodies (mAbs) have become an increasing source of biological treatments. Clinicians should make an effort to update their knowledge on mechanisms of action, indications, and adverse events of these novel therapies. Most of them have immunosuppressive effects and, therefore, vaccination is indicated. AREAS COVERED: vaccination of patients under mAbs therapies. EXPERT OPINION: Recommendations on vaccination are still based on expert recommendations and have not been updated in recent years. Specific recommendations for each mAb have not been addressed in the current literature. The aim of this comprehensive review was to collect all the therapeutic mAbs approved up to 1 January 2020 and, based on previous recommendations and the pharmaceutical characteristics of each drug, to propose an updated guide with recommendations on vaccination. Influenza, sequential pneumococcal and Hepatitis B vaccination in patients with negative serology were the only consistent recommendations. Hepatitis A vaccination was proposed for mAbs with special hepatotoxic characteristics. Other vaccines are reviewed and discussed. Several non-immunosuppressive mAbs were detected and, therefore, vaccinations not recommended. We hope that this review can serve as a starting point for compiling updated vaccination recommendations and collecting all the therapeutic mAbs approved up to 2020.

Parkinson's disease and tea: a quantitative review.

PURPOSE: To evaluate the risk of PD associated with tea consumption. MATERIAL AND METHODS: We reviewed all observational studies that evaluated the association between PD risk and tea consumption. Only, 12 studies were identified: 11 case-control and 1 cohort. These studies were carried out between 1981 and 2003. The studies represented different populations from 3 continents; North America, Europe and Asia. The 3 studies from Asia were case-control studies of Chinese populations. RESULTS: There was a clear protective effect of tea consumption in the pooled risk estimate [OR: 0.83 (95% confidence interval 0.74 to 0.92)] with 2215 cases and 145578 controls. However, the homogeneity test was significant (p value of 0.008), denoting heterogeneity across the pooled studies. Pooled analysis applying the random effect model was OR: 0.81 with 95% confidence interval nearly overlapping unity (95% confidence interval 0.67 to 0.98). Tea consumers versus non-consumers in Chinese populations had pooled OR of 0.73 with 95% confidence interval 0.60 to 0.90 (470 cases and 623 controls). The p value of homogeneity test was 0.96, denoting homogeneity across the pooled 3 studies. CONCLUSION: Tea consumption can protect against PD and this protective effect is clearer in Chinese populations. The low rate of tea consumption among persons with PD should provide us many valuable insights into the nature of the illness.

Alzheimer's disease and coffee: a quantitative review.

PURPOSE: To estimate the pooled risk of coffee consumption for Alzheimer's disease (AD). MATERIAL AND METHODS: We have reviewed all observational studies that evaluated the association between AD risk and coffee consumption. Four studies were identified: two case-control studies and two cohorts. These studies were carried out between 1990 and 2002. RESULTS: There was an obvious protective effect of coffee consumption in the pooled estimate [risk estimate: 0.73 (95% confidence interval: 0.58-0.92)]. However, the homogeneity test was highly significant (p<0.01), indicating heterogeneity across the pooled studies. Pooled analysis applying the random effect model was 0.79 with 95% confidence interval overlapping unity (95% confidence interval: 0.46-1.36). Three studies assessed coffee consumption by interview questionnaire. The risk of AD in coffee consumers versus non-consumers in studies that used interview questionnaire had a pooled risk estimate of 0.70 with 95% confidence interval 0.55-0.90. CONCLUSION: Although our pooled estimates show that coffee consumption is inversely associated with the risk of AD, the four studies had heterogeneous methodologies and results. Further prospective studies evaluating the association between coffee consumption and AD are strongly needed.

[Factors influencing hospital infection in patients in the intensive care unit]. / Factores que influyen sobre la aparición de infecciones hospitalarias en los pacientes de cuidados intensivos.

OBJECTIVE: The accumulation of risk factors in hospitalized patients is one of the elements contributing to the increase in the frequency of nosocomial infection in the intensive care unit (ICU). Our aim was to identify nosocomial infection risk factors in the ICU of our hospital. METHODS: We performed a prospective cohort study of 1,134 patients admitted to the ICU for at least 24 hours in 2001. The patients were followed-up for 48 hours after leaving the ICU. Multivariate Cox regression analysis was used to identify risk factors. RESULTS: The intrinsic risk factors identified were the principal diagnosis motivating admission to the ICU, traumatic brain injury and renal insufficiency. Invasive techniques that were independently associated with nosocomial infection (from high to low risk) were urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheter, and total parenteral nutrition. CONCLUSIONS: Although endogenous risk factors, which cannot be modified, represented the most important associated factors, steps to reduce nosocomial infections should concentrate on the following exogenous risk factors: urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheters, and total parenteral nutrition.