Background Patients with rheumatic diseases on biological therapy have a greater risk of infections. Vaccination recommendations have been established, but, the effectiveness of vaccines in these patients is not well known, and it seems to depend on the different types of treatment used.
Objectives To evaluate the response of vaccines against A and B Influenza, hepatitis B and pneumococcus in patients on biological treatment.
Methods Patients with inflammatory arthopathies, psoriasis (Pso), inflammatory bowel disease (IBD) or connective tissue diseases (CTD) that were on or were going to initiate biological therapy, were included. A and B influenza antibodies (Ab) were measured by ELISA. A good response was achieved when base-line titer was increased by four. Hepatitis B surface antibody (Hep B sAb) was measured by ELISA and considered positive with a final titer >10m IU/ml. Protection against pneumococcus serotypes 1, 3, 7F, 14, 19A and 19F was measured by an opsonophagocytosis killing assay (OPKA). Opsonization titers (OT) were defined as the serum dilution that kills 50% of bacteria.
Results 280 subjects were included, 167 women (59.6%), with a average age of 49.5±13.2 years. 35% were Rheumatoid Arthritis patients, 33.9% had spondiloarthropathies, 16.8% Psoriatic Arthritis, 5.4% Pso, 2.9% IBD and 6% other diagnostics. 84% of patients were on anti-tumor necrosis factor therapies, 8.9% on Rituximab, 5% on tocilizumab, 1.4% on abatacept and 1.4% received other biologics. 45.4% of subjects were also on DMARDs and 18% on corticosteroids. A good response to influenza A vaccine was achieved in only 3.7% of patients for A influenza and 3.2% for type B, even though the majority of patients showed detectable titers of Ab in sera. 75% of patients had been vaccinated against hepatitis B before beginning the biological therapy. More than 90% of patients vaccinated against hepatitis B during the study achieved a good response. 40% of subjects showed OT against 3 or more pneumococcal serotypes.
Conclusions The response from patients on biological therapy to the influenza vaccine is lower than expected. Comparative studies between these patients and those without biological treatment and healthy people are needed. There is a considerable amount of patients that have not received hepatitis B vaccine before the beginning of the biological treatment, although the response to this vaccine is good. Pneumococcal vaccine is successful in a considerable proportion of subjects. It is worth insisting on its administration.
Disclosure of Interest None declared