Impact of synthetic and biological disease modifying antirheumatic drugs on antibody responses to the ASO3-adjuvanted pandemic influenza vaccine

[tetano]

Impact of synthetic and biological disease modifying antirheumatic drugs on antibody responses to the ASO3-adjuvanted pandemic influenza vaccine

1. Cem Gabay1,*,?,
2. Michael Bel2,
3. Christophe Combescure3,
4. Camillo Ribi4,
5. Sara Meier2,
6. Klara Posfay-Barbe2,
7. St?phane Grillet2,
8. J?rg D. Seebach4,
9. Laurent Kaiser5,
10. Werner Wunderli5,
11. Pierre-Andr? Guerne1,
12. Claire-Anne Siegrist2,
13. for the H1N1 study group.2

DOI: 10.1002/art.30325

Copyright ? 2011 by the American College of Rheumatology


Abstract
Objectives.

To identify the determinants of antibody responses to adjuvanted split influenza A(H1N1) vaccines in patients with inflammatory rheumatic diseases.
Methods.

This prospective single-center study enrolled 173 patients (rheumatoid arthritis: 82, spondyloarthropathies: 45, others: 46) and 138 controls who received 1 (controls) or 2 (patients) doses of adjuvanted influenza A/09/H1N1 vaccine. Antibody responses were measured by hemagglutination inhibition before and 3-4 weeks after each dose. Geometric mean titres (GMT) and seroprotection rates (GMT ≥ 40) were calculated. A comprehensive medical questionnaire was used to identify the determinants of vaccine responses and adverse events.
Results.

Baseline influenza A/09/H1N1 antibodies were low in patients and controls (HAI seroprotection rates: 14.2% and 14.8% ≥ 1:40, respectively). A significant response to dose 1 was observed in both groups. However, GMT (146 vs 340, P<0.001) and seroprotection rates (74.6% versus 87%, P<0.001) remained significantly lower in patients. The second dose markedly increased patients' antibody titers, which reached similar GMTs and seroprotection rate as elicited by a single dose in healthy controls. Multivariate regression analyses identified increasing age, the use of disease modifying anti-rheumatic drugs (DMARDs) (except hydroxychloroquine and sulfasalazine) and recent (< 3 months) B cell depletion, but not TNF−α antagonists, as the main determinants of vaccine responses. Immunization was well tolerated, without any adverse impact on disease activity.
Conclusions.

DMARDs exert distinct influences on influenza vaccine responses in patients with inflammatory rheumatic diseases. Two doses of adjuvanted vaccine were necessary and sufficient to elicit similar responses in patients as 1 dose in healthy controls.

http://onlinelibrary.wiley.com/doi/10.1002/art.30325/abstract

 

[tetano]

Re: Impact of synthetic and biological disease modifying antirheumatic drugs on antibody responses to the ASO3-adjuvanted pandemic influenza vaccine

Rheumatic Disease Patients Require Two Flu Vaccine Doses


WEDNESDAY, March 23 (HealthDay News) -- Patients with inflammatory rheumatic diseases require two doses of flu vaccine to achieve the same antibody response as one dose elicits in controls, which may be due in part to the influence of specific disease-modifying antirheumatic drugs (DMARDs), according to a study published online March 7 in Arthritis & Rheumatism.

Cem Gabay, M.D., of the University of Geneva in Switzerland, and colleagues investigated the antibody response of patients with inflammatory rheumatic diseases to adjuvanted split influenza A(H1N1) vaccine, and its determinants. Antibody responses were measured in 173 patients who received two doses of adjuvanted influenza A/09/H1N1 vaccine, and 138 controls who received one dose of the vaccine. Geometric mean titers (GMT) and seroprotection rates were evaluated and a questionnaire elicited factors determining vaccine responses and side effects.

The researchers found that, although both groups had a significant response to the first vaccine dose, patients with rheumatic diseases required two doses of the vaccine to reach similar GMTs and seroprotection rates as those attained with one dose in the controls. The main determinants of lower vaccine responses were increasing age, the use of certain DMARDs, and recent B cell depletion. Immunization was well tolerated and did not have any adverse effect on disease activity.

"A second vaccine dose enabled patients with rheumatic diseases to achieve similar rates of seroprotection and antibody titers as controls. The vaccine responses were not influenced by the nature of the underlying rheumatic disease but rather by age and some types of treatment," the authors write.

http://www.modernmedicine.com/moder...Article/detail/713132?contextCategoryId=40131