Ann Rheum Dis 67:713-716 doi:10.1136/ard.2007.077552
  • Concise report

The effect of anti-tumour necrosis factor α treatment on the antibody response to influenza vaccination

  1. L B S Gelinck1,
  2. A E van der Bijl2,
  3. W E P Beyer3,
  4. L G Visser1,
  5. T W J Huizinga2,
  6. R A van Hogezand4,
  7. G F Rimmelzwaan3,
  8. F P Kroon1
  1. 1
    Department of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  2. 2
    Department of Rheumatology, LUMC
  3. 3
    Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands
  4. 4
    Department of Gastro-Enterology, LUMC
  1. L B S Gelinck, MD, Department of Infectious Diseases, C05-P, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; L.B.S.Gelinck{at}
  • Accepted 2 October 2007
  • Published Online First 26 October 2007


Objectives: The effect of anti-tumour necrosis factor (TNF) therapy on the antibody responses to vaccines is the subject of ongoing debate. Therefore, we investigated the effect of the three currently available anti-TNF agents on influenza vaccination outcomes in a patient population with long-standing disease.

Methods: In a prospective cohort study, we assessed the antibody response upon influenza vaccination in 112 patients with long-standing autoimmune disease treated with immunosuppressive medication either with anti-TNF (etanercept, adalimumab or infliximab; n = 64) or without anti-TNF (n = 48) and a control group of 18 healthy individuals. Antibody responses were determined by haemagglutination inhibition assay, before and 4 weeks after vaccination.

Results: The proportion of individuals with a protective titre (⩾40) after vaccination was large (80–94%) and did not significantly differ between the three groups. Post-vaccination geometric mean antibody titres against influenza (A/H3N2 and B) were significantly lower in the 64 patients treated with anti-TNF compared with the 48 patients not receiving anti-TNF, and the healthy controls.

Conclusions: The antibody response to influenza vaccination in patients treated with anti-TNF is only modestly impaired. The proportion of patients that achieves a protective titre is not significantly diminished by the use of TNF blocking therapies.


  • Competing interests: None.

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