TY - JOUR T1 - Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 937 LP - 941 DO - 10.1136/ard.2007.077461 VL - 67 IS - 7 AU - S Oren AU - M Mandelboim AU - Y Braun-Moscovici AU - D Paran AU - J Ablin AU - I Litinsky AU - D Comaneshter AU - D Levartovsky AU - E Mendelson AU - R Azar AU - I Wigler AU - A Balbir-Gurman AU - D Caspi AU - O Elkayam Y1 - 2008/07/01 UR - http://ard.bmj.com/content/67/7/937.abstract N2 - Objective: To assess the effect of rituximab on the efficacy and safety of influenza virus vaccine in patients with rheumatoid arthritis (RA). Methods: The study group comprised patients with RA treated with conventional disease-modifying drugs with or without rituximab. Split-virion inactivated vaccine containing 15 μg haemagglutinin/dose of B/Shanghai/361/02 (SHAN), A/New Caledonian/20/99 (NC) (H1N1) and A/California/7/04 (CAL) (H3N2) was used. Disease activity was assessed by the number of tender and swollen joints, duration of morning stiffness and evaluation of pain on the day of vaccination and 4 weeks later. CD19-positive cell levels were assessed in rituximab-treated patients. Haemagglutination inhibition (HI) antibodies were tested and response was defined as a greater than fourfold rise 4 weeks after vaccination or seroconversion in patients with a non-protective baseline level of antibodies (<1/40). Geometric mean titres (GMT) were calculated in all subjects. Results: The participants were divided into three groups: RA (n = 29, aged 64 (12) years), rituximab-treated RA (n = 14, aged 53 (15) years) and healthy controls (n = 21, aged 58 (15) years). All baseline protective levels of HI antibodies and GMT were similar. Four weeks after vaccination, there was a significant increase in GMT for NC and CAL antigens in all subjects, but not for the SHAN antigen in the rituximab group. In rituximab-treated patients, the percentage of responders was low for all three antigens tested, achieving statistical significance for the CAL antigen. Measures of disease activity remained unchanged. Conclusion: Influenza virus vaccine generated a humoral response in all study patients with RA and controls. Although the response was significantly lower among rituximab-treated patients, treatment with rituximab does not preclude administration of vaccination against influenza. ER -