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Ann Rheum Dis doi:10.1136/ard.2007.077552

The effect of anti-tumor necrosis factor alpha treatment on the antibody response to influenza vaccination

  1. L BS Gelinck (l.b.s.gelinck{at}lumc.nl)
  1. Leiden University Medical Center, Netherlands
    1. A E van der Bijl (a.e.van_der_bijl{at}lumc.nl)
    1. Leiden University Medical Center, Netherlands
      1. W EP Beyer (wbeyer{at}planet.nl)
      1. ErasmusMC, Netherlands
        1. L G Visser (l.g.visser{at}lumc.nl)
        1. Leiden University Medical Center, Netherlands
          1. T WJ Huizinga (t.w.j.huizinga{at}lumc.nl)
          1. Leiden University Medical Center, Netherlands
            1. R A van Hogezand (r.a.van_hogezand{at}lumc.nl)
            1. Leiden University Medical Center, Netherlands
              1. G F Rimmelzwaan (g.rimmelzwaan{at}erasmusmc.nl)
              1. ErasmusMC, Netherlands
                1. F P Kroon (f.p.kroon{at}lumc.nl)
                1. Leiden University Medical Center, Netherlands
                  • Published Online First 26 October 2007

                  Abstract

                  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

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