RT Journal Article
SR Electronic
T1 Reduced seroprotection after pandemic H1N1 influenza adjuvant-free vaccination in patients with rheumatoid arthritis: implications for clinical practice
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 2144
OP 2147
DO 10.1136/ard.2011.152983
VO 70
IS 12
A1 Ana C M Ribeiro
A1 Lissiane K N Guedes
A1 Julio C B Moraes
A1 Carla G S Saad
A1 Nadia E Aikawa
A1 Ana Luisa Calich
A1 Ivan L A França
A1 Jozelio F Carvalho
A1 Percival D Sampaio-Barros
A1 Celio R Goncalves
A1 Eduardo F Borba
A1 Maria do Carmo S Timenetsky
A1 Alexander R Precioso
A1 Alberto Duarte
A1 Eloisa Bonfa
A1 Ieda M M Laurindo
YR 2011
UL http://ard.bmj.com/content/70/12/2144.abstract
AB Background Reduced response to pandemic (2009) H1N1 (pH1N1) vaccine in patients with rheumatoid arthritis (RA) was recently reported. Objectives To evaluate the contribution of age, disease activity, medication and previous antibody levels to this reduced response. Methods 340 adult RA patients and 234 healthy controls were assessed before and 21 days after adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. Disease activity (DAS28), current treatment and pH1N1 antibody titres were collected. Seroprotection, seroconversion and factor increase in geometric mean titre (GMT) were calculated and adverse events registered. Results RA and controls showed similar (p>0.05) prevaccination GMT (8.0 vs 9.3) and seroprotection (10.8% vs 11.5%). After vaccination a significant reduction (p<0.001) was observed in all endpoints: GMT and factor increase in GMT, seroprotection and seroconversion rates. Disease activity did not preclude seroconversion or seroprotection and remained unchanged in 97.4% of patients. Methotrexate was the only disease-modifying antirheumatic drug associated with reduced responses (p=0.001). Vaccination was well tolerated. Conclusions The data confirmed both short-term anti-pH1N1 vaccine safety and, different from most studies with seasonal influenza, reduced seroprotection in RA patients, unrelated to disease activity and to most medications (except methotrexate). Extrapolation of immune responses from one vaccine to another may therefore not be possible and specific immunisation strategies (possibly booster) may be needed. Clinicaltrials.gov no NCT01151644.