Reduced seroprotection after pandemic H1N1 influenza adjuvant-free vaccination in patients with rheumatoid arthritis: implications for clinical practice

Abstract

Background Reduced response to pandemic (2009) H1N1 (pH1N1) vaccine in patients with rheumatoid arthritis (RA) was recently reported. Objectives To evaluate the contribution of age, disease activity, medication and previous antibody levels to this reduced response. Methods 340 adult RA patients and 234 healthy controls were assessed before and 21 days after adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. Disease activity (DAS28), current treatment and pH1N1 antibody titres were collected. Seroprotection, seroconversion and factor increase in geometric mean titre (GMT) were calculated and adverse events registered. Results RA and controls showed similar (p>0.05) prevaccination GMT (8.0 vs 9.3) and seroprotection (10.8% vs 11.5%). After vaccination a significant reduction (p<0.001) was observed in all endpoints: GMT and factor increase in GMT, seroprotection and seroconversion rates. Disease activity did not preclude seroconversion or seroprotection and remained unchanged in 97.4% of patients. Methotrexate was the only disease-modifying antirheumatic drug associated with reduced responses (p=0.001). Vaccination was well tolerated. Conclusions The data confirmed both short-term anti-pH1N1 vaccine safety and, different from most studies with seasonal influenza, reduced seroprotection in RA patients, unrelated to disease activity and to most medications (except methotrexate). Extrapolation of immune responses from one vaccine to another may therefore not be possible and specific immunisation strategies (possibly booster) may be needed. Clinicaltrials.gov no NCT01151644.

Effective seroconversion and safety following the pandemic influenza vaccination (anti-H1N1) in patients with juvenile idiopathic arthritis

“…Similarly, a satisfactory immunogenicity was observed with seasonal influenza vaccination in previous studies with juvenile rheumatic diseases (12), including JIA patients (14). By contrast, our recent report evidenced reduced humoral immune response for the same vaccine in adult rheumatoid arthritis, particularly in those under MTX therapy (23).…”

Effect of Methotrexate, Anti–Tumor Necrosis Factor α, and Rituximab on the Immune Response to Influenza and Pneumococcal Vaccines in Patients With Rheumatoid Arthritis: A Systematic Review and Meta‐Analysis

“…Indeed, influenza vaccination is seasonal, so seroprotection rates at baseline actually reflect the immune response to the vaccination the previous year and are a marker of longterm response. In 3 studies, seroprotection rates at baseline were compared between patients receiving MTX and healthy controls, and the meta-analysis of their results showed lower seroprotection induced by MTX (17,30,32) (see Supplementary Figure 1, available in the online version of this article at http://onlinelibrary.wiley.com/doi/ 10.1002/acr.22246/abstract).…”

Vacinação em pacientes da Coorte Brasília de artrite reumatoide inicial

“…Em estudo brasileiro com pacientes com AR, a vacina foi bem tolerada e segura, apesar de menor soroconversão. 32 As infecç ões nos pacientes com AR ganharam maior preocupação com o surgimento dos chamados agentes bioló-gicos, que incluem os inibidores do fator de necrose tumoral alfa (anti-TNF␣), rituximabe, tocilizumabe, abatacepte. Geralmente, esses medicamentos são utilizados em associação com as DMCDs tradicionais, aumentando-se ainda mais o efeito imunossupressor das medicaç ões.…”