Table 2 Comparison of study outcomes of the publications reporting influenza vaccination results in patients treated with anti-TNF
StudyPopulationnAnti-TNF type (n)Duration anti-TNFMethotzrexate(%)Mean age(years)GMTs*Protection rates†Author conclusions
Gelinck (present study)Mixed64i/e/a (29/14/21)2y6551−60/−35/−57−6/−5/−9“significant inhibition of GMTs by anti-TNF, without lowering protection rates”
487647Reference group
HC1847+25/+35/+14+11/+5/+1
Kaine 20077RA99a1 week (40 mg)5652−22/−14/−20−19‡“adalimumab does not diminish humoral response, the majority of patients are protected”
1095451Reference group
Kapetanovic 20068RA50i/e (37/13)0.7y10053−42/−70/−49−26/−42/−12“immune response sufficiently large, regardless of treatment”
62i/e (27/35)1.1y054+12/−60/−39−3/−35/−8
3710061Reference group
HC1830§−15/−31/−61−5/−12/−29
Fomin 20069RA27i/e (22/5)⩾3mo6859Not reported separately+31/+27/+18¶“infliximab does not affect the humoral response”
55reference group
HC3053+9/+9/+15+2/+28/+30**
  • The study outcomes are expressed as percentage higher (+) or lower (–) post-vaccination outcomes in the different study groups as compared with a reference patient group.

  • *Relative percentage higher or lower post-vaccination GMTs as compared with reference patient group (for, respectively, influenza A/H3N2, A/H1N1 and influenza B); “−70” indicates a post-vaccination titre 70% lower than the reference group.

  • †Relative percentage higher or lower protection rate as compared with reference patient group (for, respectively, influenza A/H3N2, A/H1N1 and influenza B), unless stated otherwise; “+10” indicates a (relative) 10% higher protection rate as compared with the reference group.

  • ‡Pooled data of three antigens (protective antibodies against ⩾2 of 3 influenza antigens).

  • §Based on mean age of 47 healthy controls in pneumococcal vaccination study.

  • ¶Difference (%) in percentage of responders (defined as either seroconversion or a fourfold titre increase in patients with a protective titre before vaccination) in patients treated with infliximab (n = 22) versus no infliximab (n = 60, including five patients with etanercept).

  • **Difference (%) in percentage of responders (defined as either seroconversion or a fourfold titre increase in patients with a protective titre before vaccination) in all patients (n = 82) versus healthy controls (n = 30)

  • anti-TNF, anti-tumour necrosis factor α therapy; GMT, geometric mean titre; RA, rheumatoid arthritis; HC, healthy control; i, infliximab; a, adalimumab; e, etanercept; y, years; mo, months.