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Impact of tocilizumab therapy on antibody response to influenza vaccine in patients with rheumatoid arthritis
  1. Shunsuke Mori1,
  2. Yukitaka Ueki2,
  3. Naoyuki Hirakata2,
  4. Motohiro Oribe3,
  5. Toshihiko Hidaka4,
  6. Kazunori Oishi5
  1. 1Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
  2. 2Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Nagasaki, Japan
  3. 3Oribe Rheumachika-Naika Clinic, Oita, Japan
  4. 4Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
  5. 5Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
  1. Correspondence to Dr Shunsuke Mori, Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan; moris{at}saisyunsou1.hosp.go.jp

Abstract

Objectives We assessed the influence of tocilizumab (TCZ), a humanised monoclonal anti-interleukin-6 receptor antibody, on antibody response following influenza vaccination in patients with rheumatoid arthritis (RA).

Methods A total of 194 RA patients received inactive trivalent influenza vaccination (A/H1N1, A/H3N2 and B/B1 strains). All patients were classified into the TCZ (n=62), TCZ+methotrexate (MTX) (n=49), MTX (n=65) and RA control (n=18) groups. Antibody titres were measured before and 4–6 weeks after vaccination using the haemagglutination inhibitory assay.

Results For the A/H1N1 and A/H3N2 strains, the TCZ and TCZ+MTX groups achieved fold increases of 9.9–14.5, postvaccination seroprotection rates greater than 70% and seroresponse rates greater than 40%. For the B/B1 strain, seroresponse rates were approximately 30%, but fold increases and seroprotection rates were 5.0–5.4 and greater than 70%, respectively, in these treatment groups. MTX had a negative impact on vaccination efficacy, but adequate responses for protection were nevertheless demonstrated in the MTX group. Neither severe adverse effects nor RA flares were observed.

Conclusions TCZ does not hamper antibody response to influenza vaccine in RA patients. Influenza vaccination is considered effective in protecting RA patients receiving TCZ therapy with or without MTX.

  • Infections
  • Rheumatoid Arthritis
  • Vaccination

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