CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Wegener’s granulomatosis patients show an adequate antibody response to influenza vaccination

A Holvast¹, C A Stegeman¹, C A Benne², A Huckriede³, J C Wilschut³, A M Palache⁴, C G M Kallenberg¹, M Bijl¹

¹ Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
² Laboratory for Infectious Diseases, Groningen, The Netherlands
³ Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
⁴ Solvay Pharmaceuticals, Weesp, The Netherlands

Dr A Holvast, Department of Internal Medicine, Division of Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; B.Holvast{at}int.umcg.nl

Objectives: Wegener’s granulomatosis (WG) is a systemic vasculitis characterised by relapsing and remitting disease activity. Immunosuppressive drugs are used to control disease, but increase susceptibility to infection. Therefore, influenza vaccination should be considered in WG patients. This study was performed to assess the immunogenicity of influenza vaccination in WG patients.

Methods: A randomised, controlled trial was performed in WG patients with quiescent disease, defined as a Birmingham vasculitis activity score (BVAS) less than 2. Patients were randomly assigned to receive influenza vaccination (n = 49) or to participate as controls (n = 23). In addition, healthy controls (n = 49) were vaccinated. At entry and at 1 and 3–4 months after entry, antibody responses to vaccination were determined. Furthermore, disease activity was measured (BVAS), adverse effects were recorded and antineutrophil cytoplasmic autoantibody (ANCA) titres were determined.

Results: WG patients achieved high seroprotection rates to all three influenza strains, comparable with healthy controls. Only the A/H1N1 strain patients had a lower seroconversion rate (p = 0.002) and geometric mean titre (p = 0.037) than controls. After 1 month, one control and one vaccinated WG patient had developed active disease. At 3–4 months, two additional control patients had developed active disease compared with none of the vaccinated patients (p = 0.099). Vaccination did not influence ANCA titres. Adverse effects did not differ between patients and healthy controls.

Conclusions: Influenza vaccination in WG patients with quiescent disease induced a sufficient antibody response.

Trial registration number: NTR1130.

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