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AB0246 Study of the Antibody Titer by Influenza Vaccination in Rheumatoid Arthritis Patients Treated with Biological Agents -Examination of Multiple Dose-
  1. H. Ishikawa1,2,
  2. A. Kaneko2,
  3. Y. Hattori2,
  4. D. Kida2,
  5. M. Katayama3,
  6. T. Sato2,
  7. Y. Osawa1
  1. 1Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  2. 2Orthopaedic Surgery and Rheumatology
  3. 3Rheumatology, Nagoya Medical Center, Nagoya, Japan


Background Biologic agents might suppress the immune response to influenza vaccines, but, the report is limited to the number of papers.

Objectives The aim is the study to compare antibody titers change after multiple dose influenza vaccination for rheumatoid arthritis (RA) patients who have been treat with abatacept (ABT), tocilizumab (TCZ), golimumab (GLM).

Methods In 1356 cases of RA patients registered in Nagoya medical center, patients using biologics were 532 cases. Of which, 134 patients with RA (ABT; n=37, TCZ; n=80, and GLM; n=17) received twice inactive trivalent influenza vaccination (A/H1N1, A/H3N2, B/B-1 strains). The second inoculation was one month after the first. Antibody titer were measured before and one and two month after vaccination using the haemagglutination inhibitory assay.

Results The rate of pre-inoculation (17.60% - 20.00%) which was low at all Biologics for H1N1. TCZ, and GLM showed a similar effect, in Seroprotection rate was observed effect a single and multiple times inoculations. Compared to other agents, single and multiple times inoculations also, it had to be limited in ABT but was observed effects. In Seroconversion rate, TCZ, GLM was found effective in both single, and multiple times inoculations even in Seroconversion rate. But, ABT had been limited to the effect.

The rate of pre-inoculation was (48.80% - 41.20%) higher in all Biologics for H3N2. Single, and multiple times inoculations, in Seroprotection rate showed an effect together with all drugs. In Seroconversion rate even acknowledged the effect of all drugs, too.

In the GLM and ABT group for type B, the effect of multiple doses was not observed, but it showed effect a little in the TCZ group.

On the whole, TCZ group were observed effects of the vaccine most in Biologics, the effect of multiple doses were high.

Conclusions We reported in EULAR2013, TCZ group were good response, and that there is less response tendency for ABT group, even compared with controls (RA patients treated by MTX) in effect by single dose of a vaccine,

In our result, it was considered, the effect of multiple doses is not small, and should be performed if possible multiple doses in all Biologics.

In ABT group, We think the low effect of the vaccine in a single dose, and the effect of multiple doses was low in fact, but multiple doses can be beneficial in some serotypes.


  1. Kapetanovic MC, Saxne T, Nilsson JA, et al. Influenza vaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients. Rheumatology (Oxford) 2007;46:608–11.

  2. Kubota T, Nii T, Nanki T, et al. Anti-tumor necrosis factor therapy does not diminish the immune response to influenza vaccine in Japanese patients with rheumatoid arthritis. Mod Rheumatol 2007;17:531–3.

  3. Mori S, Ueki Y, Hirakata N, et al. Impact of tocilizumab therapy on antibody response to influenza vaccine in patients with rheumatoid arthritis.Ann Rheum Dis 2012;71:2006–2010.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.1975

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