Immunogenicity of influenza H1N1 vaccination in mixed connective tissue disease: effect of disease and therapy

Abstract

OBJECTIVE:To assess the potential acute effects regarding the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with mixed connective tissue disease and healthy controls.METHODS:Sixty-nine mixed connective tissue disease patients that were confirmed by Kasukawa's classification criteria and 69 age- and gender-matched controls participated in the study; the participants were vaccinated with the non-adjuvanted influenza A/California/7/2009 (H1N1) virus-like strain. The percentages of seroprotection, seroconversion, geometric mean titer and factor increase in the geometric mean titer were calculated. The patients were clinically evaluated, and blood samples were collected pre- and 21 days post-vaccination to evaluate C-reactive protein, muscle enzymes and autoantibodies. Anti-H1N1 titers were determined using an influenza hemagglutination inhibition assay. ClinicalTrials.gov: NCT01151644.RESULTS:Before vaccination, no difference was observed regarding the seroprotection rates (p = 1.0) and geometric mean titer (p = 0.83) between the patients and controls. After vaccination, seroprotection (75.4% vs. 71%, p = 0.7), seroconversion (68.1% vs. 65.2%, p = 1.00) and factor increase in the geometric mean titer (10.0 vs. 8.0, p = 0.40) were similar in the two groups. Further evaluation of seroconversion in patients with and without current or previous history of muscle disease (p = 0.20), skin ulcers (p = 0.48), lupus-like cutaneous disease (p = 0.74), secondary Sjögren syndrome (p = 0.78), scleroderma-pattern in the nailfold capillaroscopy (p = 1.0), lymphopenia ≤1000/mm3 on two or more occasions (p = 1.0), hypergammaglobulinemia ≥1.6 g/d (p = 0.60), pulmonary hypertension (p = 1.0) and pulmonary fibrosis (p = 0.80) revealed comparable rates. Seroconversion rates were also similar in patients with and without immunosuppressants. Disease parameters, such as C-reactive protein (p = 0.94), aldolase (p = 0.73), creatine phosphokinase (p = 0.40) and ribonucleoprotein antibody levels (p = 0.98), remained largely unchanged pre and post-vaccination. No severe side effects were reported.CONCLUSIONS:The non-adjuvanted influenza A/H1N1 vaccination immune response in mixed connective tissue disease patients is adequate and does not depend on the disease manifestations and therapy.

2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

“…Most studies investigating immunogenicity and safety of the pandemic monovalent influenza vaccine found reduced immunogenicity in AIIRD patients (mostly RA and SLE) and on most immunosuppressive medications, although protective antibody levels were reached in the majority of patients,34 35 38 40 59 89 105–116 except for those treated with rituximab and abatacept 38 42 117. A second booster dose of vaccine was shown to improve immunogenicity, leading to levels of seroprotection comparable to healthy controls 40 42 118.…”

Lymphopenia in early arthritis: Impact on diagnosis and 3-year outcomes (ESPOIR cohort)

“…Some studies used 1500/mm 3 [36] and others 1000/mm 3 [14][15][16][17][18][19][20]. We used the lower of these two cut-offs, which was chosen for most of the previous studies.…”

“…In our study, lymphopenia was defined as a peripheral blood lymphocyte count < 1000/mm 3 , cut-off considered as the most relevant in previous studies [14][15][16][17][18][19][20].…”

La lymphopénie dans la polyarthrite débutante : impact sur le diagnostic et les résultats à 3ans (la cohorte Espoir)

“…Certaines études donnent un taux de lymphocytes sanguins < 1500/mm 3 [36] et autres < 1000 mm 3 [14][15][16][17][18][19][20]. Nous avons utilisé la valeur seuil la plus basse, qui a été choisie pour la plupart des études précédentes.…”

“…Dans notre étude, la lymphopénie a été définie comme un taux de lymphocytes sanguins circulant < 1000/mm 3 , valeur seuil considérée comme la plus pertinente dans les études précédentes [14][15][16][17][18][19][20].…”