Abstract Rationale Patients with idiopathic pulmonary fibrosis (IPF) are at increased risk for respiratory infections, which contribute significantly to morbidity and mortality. The Centers for Disease Control and Prevention (CDC) recommend pneumococcal vaccination for adults with chronic lung diseases, including IPF. However, major guidelines—including the CDC, American Thoracic Society, and Pulmonary Fibrosis Foundation—do not specify a preferred regimen between the 20-valent pneumococcal conjugate vaccine (PCV20) and the sequential strategy of PCV13/15 followed by the pneumococcal polysaccharide vaccine (PPSV23). Data directly comparing these vaccination strategies in IPF are limited. Objectives This study aims to compare clinical outcomes between PCV20 monovaccine and sequential PCV13/15 followed by PPSV23 vaccination among adults with idiopathic pulmonary fibrosis. Methods Using TriNetX, a global health research network aggregating de-identified patient data from 71 healthcare organizations across the United States, we conducted a retrospective cohort study. Inclusion criteria were adults aged ≥18 years with a diagnosis of idiopathic pulmonary fibrosis who received either PCV20 or sequential pneumococcal vaccination (PCV13/15 + PPSV23). Propensity score matching (1:1) was performed to control for demographic and clinical variables, yielding 551 patients per group. Outcomes assessed over one year post-vaccination included all-cause mortality, non-specific pneumonia (J18), and acute respiratory failure. Results Following propensity score matching, 551 patients were included in each cohort, with a mean age of 68 years and 52% male. Compared with the sequential vaccination group, the PCV20 cohort demonstrated a lower risk of all-cause mortality (6.9% vs 10.7%; risk ratio RR 0.64; 95% confidence interval CI 0.43-0.95; p = 0.024) and non-specific pneumonia (10.2% vs 14.2%; RR 0.72; 95% CI 0.52-0.99; p = 0.043). The incidence of acute respiratory failure was comparable between groups (2.2% vs 2.7%; RR 0.80; 95% CI 0.38-1.69; p = 0.56). Conclusions In adults with idiopathic pulmonary fibrosis, PCV20 vaccination was associated with significantly lower all-cause mortality and pneumonia risk within one year compared to sequential pneumococcal vaccination. These findings suggest that single-dose PCV20 may provide enhanced protection and a simpler strategy for pneumococcal prevention in this high-risk population. This abstract is funded by: None
Alachraf et al. (Fri,) studied this question.