Effect of Disease-modifying Antirheumatic Drug Therapy on Immune Response to Trivalent Influenza Vaccine in Rheumatoid Arthritis

Overview

Journal Indian J Med Res

Specialty General Medicine

Date 2017 Sep 2

PMID 28862177

Citations 5

Authors

Vikramraj K Jain

Nandhini Bhashini

L Karthik Balajee

Sujatha Sistla

Subhash Chandra Parija

Vir Singh Negi

Affiliations

Soon will be listed here.

Abstract

Background & Objectives: Patients with autoimmune rheumatic diseases may be at an increased risk of infection due to disease and use of disease-modifying antirheumatic drug (DMARD) therapy. The present study was done to evaluate the immune response to influenza vaccination in patients with rheumatoid arthritis (RA).

Methods: Fifty one RA patients on stable methotrexate (MTX) therapy (≥15 mg/wk), 51 newly diagnosed DMARD-naïve RA patients and 45 healthy controls received a single dose of inactivated seasonal trivalent influenza vaccine. Blood samples were collected just prior to and four weeks after vaccination. Pre- and post-vaccination antibody titres against the three virus strains were measured by hemagglutination inhibition assay. The impact of age, gender, DMARD treatment and pre-vaccination seroprotection on response to the vaccine was assessed by binary logistic regression analysis for each of the virus strains.

Results: Pre-vaccination antibody titres were found to be high in the three study groups for all influenza strains, except for Yamagata strain, the titres for which were low in healthy controls. Trivalent influenza vaccination was found to be safe and stimulated a good antibody response in all study groups. On regression analysis, there was no association of age, gender or MTX therapy with vaccine response, except for Yamagata strain where healthy controls had higher positive immune response (P=0.008; odds ratio - 3.37, 95% confidence interval: 1.36-8.32).

Interpretation & Conclusions: Our results indicated that influenza vaccination was safe in RA patients with no detrimental effect on disease activity. MTX therapy at a dose ≥15 mg/wk did not affect the vaccine response. Presence of high pre-vaccination seroprotective antibody levels in the study population indicates the need for re-examination of recommended annual influenza vaccination in such subgroups of population.

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References

Aletaha D, Neogi T, Silman A, Funovits J, Felson D, Bingham 3rd C . 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010; 69(9):1580-8. DOI: 10.1136/ard.2010.138461. View

Kapetanovic M, Saxne T, Nilsson J, Geborek P . Influenza vaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients. Rheumatology (Oxford). 2006; 46(4):608-11. DOI: 10.1093/rheumatology/kel366. View

Hua C, Barnetche T, Combe B, Morel J . Effect of methotrexate, anti-tumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2013; 66(7):1016-26. DOI: 10.1002/acr.22246. View

Tang J, Tambyah P, Wilder-Smith A, Puong K, Shaw R, Barr I . Cross-reactive antibodies to pandemic (H1N1) 2009 virus, Singapore. Emerg Infect Dis. 2010; 16(5):874-6. PMC: 2954004. DOI: 10.3201/eid1605.091678. View

Prevoo M, van t Hof M, Kuper H, van Leeuwen M, van de Putte L, van Riel P . Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995; 38(1):44-8. DOI: 10.1002/art.1780380107. View

Gabay C, Bel M, Combescure C, Ribi C, Meier S, Posfay-Barbe K . Impact of synthetic and biologic disease-modifying antirheumatic drugs on antibody responses to the AS03-adjuvanted pandemic influenza vaccine: a prospective, open-label, parallel-cohort, single-center study. Arthritis Rheum. 2011; 63(6):1486-96. DOI: 10.1002/art.30325. View

Reilly P, Cosh J, Maddison P, Rasker J, Silman A . Mortality and survival in rheumatoid arthritis: a 25 year prospective study of 100 patients. Ann Rheum Dis. 1990; 49(6):363-9. PMC: 1004101. DOI: 10.1136/ard.49.6.363. View

Alamanos Y, Drosos A . Epidemiology of adult rheumatoid arthritis. Autoimmun Rev. 2005; 4(3):130-6. DOI: 10.1016/j.autrev.2004.09.002. View

You F, Sun N, Ma G, Wang M, Sa D, Shi C . [A survey of levels of antibodies against influenza viruses in the population of Wuxi City]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2012; 25(5):351-4. View

10.

Ribeiro A, Guedes L, Moraes J, Saad C, Aikawa N, Calich A . Reduced seroprotection after pandemic H1N1 influenza adjuvant-free vaccination in patients with rheumatoid arthritis: implications for clinical practice. Ann Rheum Dis. 2011; 70(12):2144-7. DOI: 10.1136/ard.2011.152983. View

11.

Agmon-Levin N, Paz Z, Israeli E, Shoenfeld Y . Vaccines and autoimmunity. Nat Rev Rheumatol. 2009; 5(11):648-52. DOI: 10.1038/nrrheum.2009.196. View

12.

Kapetanovic M, Kristensen L, Saxne T, Aktas T, Morner A, Geborek P . Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritis. Arthritis Res Ther. 2014; 16(1):R2. PMC: 3978632. DOI: 10.1186/ar4427. View

13.

Miller E, Hoschler K, Hardelid P, Stanford E, Andrews N, Zambon M . Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study. Lancet. 2010; 375(9720):1100-8. DOI: 10.1016/S0140-6736(09)62126-7. View

14.

Agarwal N, Ollington K, Kaneshiro M, Frenck R, Melmed G . Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review. Vaccine. 2011; 30(8):1413-24. DOI: 10.1016/j.vaccine.2011.11.109. View

15.

Tandale B, Pawar S, Gurav Y, Chadha M, Koratkar S, Shelke V . Seroepidemiology of pandemic influenza A (H1N1) 2009 virus infections in Pune, India. BMC Infect Dis. 2010; 10:255. PMC: 2936412. DOI: 10.1186/1471-2334-10-255. View

16.

Singh J, Furst D, Bharat A, Curtis J, Kavanaugh A, Kremer J . 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012; 64(5):625-39. PMC: 4081542. DOI: 10.1002/acr.21641. View

17.

Adler S, Krivine A, Weix J, Rozenberg F, Launay O, Huesler J . Protective effect of A/H1N1 vaccination in immune-mediated disease--a prospectively controlled vaccination study. Rheumatology (Oxford). 2011; 51(4):695-700. DOI: 10.1093/rheumatology/ker389. View

18.

Choudhry A, Singh S, Khare S, Rai A, Rawat D, Aggarwal R . Emergence of pandemic 2009 influenza A H1N1, India. Indian J Med Res. 2012; 135(4):534-7. PMC: 3385239. View

19.

Kapetanovic M, Saxne T, Sjoholm A, Truedsson L, Jonsson G, Geborek P . Influence of methotrexate, TNF blockers and prednisolone on antibody responses to pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis. Rheumatology (Oxford). 2005; 45(1):106-11. DOI: 10.1093/rheumatology/kei193. View

20.

Kumar A, Malaviya A, Pandhi A, Singh R . Validation of an Indian version of the Health Assessment Questionnaire in patients with rheumatoid arthritis. Rheumatology (Oxford). 2002; 41(12):1457-9. DOI: 10.1093/rheumatology/41.12.1457. View