Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis

Abstract

Objective:To investigate the effect of teriflunomide on the efficacy and safety of seasonal influenza vaccine.Methods:The 2011/2012 seasonal influenza vaccine (containing H1N1, H3N2, and B strains) was administered to patients with relapsing forms of multiple sclerosis (RMS) treated for ≥6 months with teriflunomide 7 mg (n = 41) or 14 mg (n = 41), or interferon-β-1 (IFN-β-1; n = 46). The primary endpoint was the proportion of patients with influenza strain–specific antibody titers ≥40, 28 days postvaccination.Results:More than 90% of patients achieved postvaccination antibody titers ≥40 for H1N1 and B in all groups. For H3N2, titers ≥40 were achieved in ≥90% of patients in the 7 mg and IFN-β-1 groups, and in 77% of the 14-mg group, respectively. A high proportion of patients already had detectable antibodies for each influenza strain at baseline. Geometric mean titer ratios (post/prevaccination) were ≥2.5 for all groups and strains, except for H1N1 in the 14-mg group (2.3). The proportion of patients with a prevaccination titer <40 achieving seroprotection was ≥61% across the 3 treatment groups and 3 influenza strains. However, fewer patients in the 14-mg than the 7-mg or IFN-β-1 groups exhibited seroprotection to H3N2 (61% vs 78% and 82%, respectively).Conclusion:Teriflunomide-treated patients generally mounted effective immune responses to seasonal influenza vaccination, consistent with preservation of protective immune responses.Classification of evidence:This study provides Class II evidence that teriflunomide generally does not adversely impact the ability of patients with RMS to mount immune responses to influenza vaccination.

Immune Response to Seasonal Influenza Vaccine in Patients with Relapsing-Remitting Multiple Sclerosis Receiving Long-term Daclizumab Beta

“…15 Positive responses to influenza vaccine also have been observed with other treatments for RRMS. 6,[16][17][18][19] A similar proportion of patients with MS who were or were not treated with interferon beta-1a mounted an appropriate immune response to inactivate the influenza vaccine, and no new safety concerns were noted. 18 In an exploratory study of immunomodulatory treatments, rates of protection were lower in patients treated with glatiramer acetate, natalizumab, …”

Interdisciplinary Risk Management in the Treatment of Multiple Sclerosis

“…Nevertheless, 13 cases of basal cell carcinoma and six cases of melanoma occurred in the licensing studies for fingolimod. After approval of this drug, further isolated cases of skin tumors (e26, 30) and lymphomatous disease (B-and T-cell lymphomas, (23) Slightly reduced response (24) No studies in MS 43% (fingolimod) compared with 75% (placebo) (25) H1N1 2009: 0% (mitoxantrone) versus 43.5% (untreated HC) (23) Inconsistent results: reduction of vaccination response (23.5% [natalizumab] versus 43.5% [untreated HC]) or unchanged response (23) Debatably no reduction in vaccination response; vaccination against influenza is expressly recommended, possibly with repeat vaccination if the titer is too low: all vaccinations in patients on alemtuzumab should be given at least 6 months after the most recent infusion (26) No studies in MS Deutsches Ärzteblatt International | Dtsch Arztebl Int 2016; 113: 879-86…”

Teriflunomide in relapsing multiple sclerosis: therapeutic utility

“…In a phase III clinical study, mean reductions in lymphocyte and neutrophil counts were small in magnitude, remained within the normal range, and were reversible after treatment discontinuation, or on treatment in some cases . A low incidence of serious opportunistic infections [O'Connor et al 2011b], and the ability of subjects to mount effective immune responses to seasonal influenza vaccination [Bar-Or et al 2012], provide further evidence for the preservation of the immune system in teriflunomide-treated patients.…”