Objectives: The effect of anti-TNF therapy on the antibody responses to vaccines is 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 longstanding disease.
Methods: In a prospective cohort study, we assessed the antibody response upon influenza vaccination in 112 patients with longstanding 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 hemagglutination inhibition assay, before and four weeks after vaccination.
Results: The proportion of individuals with a protective titer (≥40) after vaccination was large (80 to 94%) and did not significantly differ between the three groups. Postvaccination geometric mean antibody titers against influenza (A/H3N2 and B) were significantly lower in the 64 patients treated with anti-TNF compared to 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 titer is not significantly diminished by the use of TNF blocking therapies