Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritis

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• 作者：Meliha C Kapetanovic (1)
  Lars-Erik Kristensen (1)
  Tore Saxne (1)
  Teodora Aktas (2)
  Andreas M枚rner (2)
  Pierre Geborek (1)
  
• 刊名：Arthritis Research & Therapy
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：16
• 期：1
• 全文大小：
• 作者单位：Meliha C Kapetanovic (1)
  Lars-Erik Kristensen (1)
  Tore Saxne (1)
  Teodora Aktas (2)
  Andreas M枚rner (2)
  Pierre Geborek (1)
  
  1. Department of Clinical Sciences, Section of Rheumatology Lund, Lund University and Sk氓ne University Hospital, Lund, Sweden
  2. Vaccinology Unit, Department of Diagnostics and Vaccinology, Swedish Institute for Communicable Disease Control, Solna, Sweden
  
• ISSN：1478-6354

文摘

Introduction An adjuvanted pandemic H1N1 influenza (pH1N1) vaccine (Pandemrix庐) was reported as highly immunogenic resulting in seroconversion in 77 to 94% of adults after administration of a single dose. The aim of the study was to investigate the impact of different anti-rheumatic treatments on antibody response to pH1N1 vaccination in patients with rheumatoid arthritis (RA) and spondylarthropathy (SpA). Methods Patients with arthritis (n鈥?鈥?91; mean age 57 years, 64% women) participated. Hemagglutination inhibition (HI) assay was performed on blood samples drawn before and after a mean (SD) of 8.3 (4) months following vaccination. A positive immune response i.e. seroconversion was defined as negative prevaccination serum and postvaccination HI titer 鈮?0 or a 鈮?-fold increase in HI titer. All patients were divided into predefined groups based on diagnosis (RA or SpA) and ongoing treatment: methotrexate (MTX), anti-tumor necrosis factor (anti-TNF) as monotherapy, MTX combined with anti-TNF, other biologics (abatacept, rituximab, tocilizumab) and non-steroidal anti-inflammatory drugs (NSAIDs)/analgesics. Predictors of positive immune response were studied using logistic regression analysis. Results The percentage of patients with positive immune response in the different treatment groups was: 1. RA on MTX 42%; 2. RA on anti-TNF monotherapy 53%; 3. RA on anti-TNF鈥?鈥塎TX 43%; 4. RA on other biologics (abatacept 20%, rituximab 10% and tocilizumab 50%); 5. SpA on anti-TNF monotherapy 76%; 6. SpA on anti-TNF鈥?鈥塎TX 47%; and 7. SpA on NSAIDs/analgesics 59%. RA patients on rituximab had significantly lower (P鈥?lt;鈥?.001) and SpA on anti-TNF monotherapy significantly better response rates compared to other treatment groups (P 0.001 to 0.033). Higher age (P鈥?lt;鈥?.001) predicted impaired immune response. Antibody titers 3 to 6 months after vaccination was generally lower compared to those within the first 3 months but no further decrease in titers were observed 6 to 22 months after vaccination. Conclusions Rituximab treatment severely reduced antibody response to pH1N1 influenza vaccine. The other treatment groups showed acceptable antibody responses. Protective antibody titers could be detected up to 22 months after vaccination in the current patient population, with the exception of rituximab treated patients.