Antigen-specific antibody responses in lupus patients following immunization

Abstract

Objective To determine the safety and efficacy of 3 clinically relevant vaccines in patients with systemic lupus erythematosus (SLE). Methods We studied 73 consecutive SLE patients immunized with pneumococcal, tetanus toxoid (TT), and Haemophilus influenzae type B (HIB) vaccines. Patients were evaluated preimmunization and 12 weeks postimmunization for disease activity and immunization side effects. Results Eighty‐four percent of the SLE patients developed a 4‐fold titer increase in response to at least 1 vaccine, with 51% developing a 2‐fold titer increase with all 3 vaccines. The majority of SLE patients developed protective levels of antibody to TT (90%) and HIB (88%). Although protective antibody levels could not be determined for pneumococcus, almost half of the patients (47%) developed a 4‐fold antibody response. There was a trend toward a lower antibody response in patients with active disease treated with immunosuppressive therapy. Overall lupus disease activity was unaffected by immunization. Conclusion Immunization is safe in SLE patients, with the overwhelming majority developing protective antibody levels. Therefore, SLE patients should receive immunizations according to the recommendations of the Centers for Disease Control and Prevention and the Immunization Practices Advisory Committee.

American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 5

“…Strong consensus was achieved regarding the statement to not delay COVID‐19 vaccination for patients receiving hydroxychloroquine, sulfasalazine, leflunomide, apremilast, or IV immunoglobulin ( 10 , 76 ). A similar recommendation with moderate consensus was achieved for most of the remaining immunomodulatory therapies considered ( 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ).…”

American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 4

“…Strong consensus was achieved regarding the statement to not delay COVID‐19 vaccination for patients receiving hydroxychloroquine, sulfasalazine, leflunomide, apremilast, or IV immunoglobulin ( 10 , 71 ). A similar recommendation with moderate consensus was achieved for most of the remaining immunomodulatory therapies considered ( 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 ).…”

Efficacy of inactivated vaccines in patients treated with immunosuppressive drug therapy

“…In a study of 73 patients with SLE on various immunosuppressive therapy regimens, administration of three inactivated vaccines, pneumococcal, tetanus toxoid (TT), and Haemophilus influenzae type B (HIib), was associated with a protective immune response in the majority of patients (90% and 88% for TT and HIB, respectively). 88 Protective immune response to pneumococcal vaccine was unable to be defined but 47% of patients had a 4‐fold antibody titer response. Similarly, in a study of 43 autoimmune patients with inflammatory bowel disease who completed at least 24 weeks of therapy with azathioprine or 6‐mercaptopurine, response to pneumococcal, TT, and HIB was similar to that of patients who were not treated with thiopurines.…”