Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease
- A Holvast1,
- A Huckriede2,
- J Wilschut2,
- G Horst1,
- J J C De Vries3,
- C A Benne3,
- C G M Kallenberg1,
- M Bijl1
- 1Department of Clinical Immunology, University Medical Center Groningen, University of Groningen, Netherlands
- 2Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen
- 3Laboratory for Infectious Diseases, Groningen
- Correspondence to:
Department of Internal Medicine, Division of Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands;
- Accepted 18 November 2005
- Published Online First 1 December 2005
Objective: to assess the safety and efficacy of influenza vaccination in patients with systemic lupus erythematosus (SLE), and to evaluate the influence of immunosuppressive drugs on the immune response.
Methods: SLE patients (n = 56) and healthy controls (n = 18) were studied. All patients had quiescent disease (SLE disease activity index ⩽5). Four patient groups were defined on the basis of their drug use: (1) no drug treatment; (2) hydroxychloroquine treatment; (3) azathioprine treatment; (4) prednisone treatment. Participants received trivalent influenza subunit vaccine during October/November 2003. Disease activity scores and side effects were recorded. Antibody titres against influenza virus were measured before and 30 days after vaccination using the haemagglutination inhibition assay.
Results: Influenza vaccination did not result in changes in disease activity and was well tolerated. SLE patients had fewer seroconversions or fourfold titre rises for A/H1N1 (p<0.001) and A/H3N2 (p<0.001) than healthy controls, while for B/Hong Kong the difference was of borderline significance (p = 0.051). With regard to immunosuppressive treatment, fewer SLE patients using azathioprine developed fourfold titre rises against A/H3N2 (p = 0.041), and fewer achieved titres of ⩾40 against A/H3N2 (p = 0.030) compared with the other patient groups.
Conclusions: Influenza vaccination in SLE patients with quiescent disease is safe but is less effective than in controls. Use of azathioprine was associated with a trend to decreased vaccination efficacy.
- GMT, geometric mean titre
- SLE, systemic lupus erythematosus
- SLEDAI, SLE disease activity index
- VAS, visual analogue score
Published Online First 1 December 2005