Patricia Richi1, María Dolores Martín2, María Teresa Navío3, Laura González-Hombrado4, Marina Salido5, Jesús Llorente6, Israel Thuissard-Vasallo7, Patricia Alcocer8, Carmen María Saa-Requejo9, Ana Jiménez-Diaz10, Laura Cebrián3, Leticia Lojo3, Marta García-Castro4, David Sanz-Rosa7, Patricia Castro5, Sandra Fernández-Rodríguez11, María José Martínez de Aramayona11, Martina Steiner10, Tatiana Cobo10, Cristina García-Fernández9, Mónica Fernández-Castro10, Óscar Illera10, Ricardo Valverde12, Santiago Muñoz-Fernández10. 1. Rheumatology Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain. Electronic address: patricia.richi@salud.madrid.org. 2. Bactereology Department, BR Salud Laboratories, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain. 3. Rheumatology Department, Infanta Leonor University Hospital, Gran Vía del Este 80, 28031 Madrid, Spain. 4. Rheumatology Department, Tajo University Hospital, Av. Amazonas Central s/n, Aranjuez, 28300 Madrid, Spain. 5. Rheumatology Department, Infanta Cristina University Hospital, Av 9 de Junio 2, Parla, 28981 Madrid, Spain. 6. Pharmacy Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain. 7. School of Doctoral Studies & Research, Europea University, Calle Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain. 8. Rheumatology Department, HM Hospital, Avenida de Manoteras n° 10, 28050 Madrid, Spain. 9. Preventive Medicine Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain. 10. Rheumatology Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain. 11. Occupational Medicine Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain. 12. Dermatology Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain.
Abstract
BACKGROUND AND OBJECTIVES: Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. MATERIAL AND METHODS: Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014-2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. RESULTS: 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p<0.001). Anti-TNF drugs were associated with better response and rituximab with the worst (79.2% vs 55.0% for final seropositivity against antigen A, p=0.020). Vaccine response in the rituximab group tended to improve when the interval between the drug administration and the vaccination was at least 12 weeks (seropositivity rate 80.0% in those with the longer interval vs 25.0% in the other group, p=0.054). CONCLUSIONS: Among the patients on biological therapy vaccinated against influenza, anti-TNF therapy was identified as a predictive factor of final seropositivity. Rituximab presented a lower rate of final seropositivity, which could be increased with an accurate administration schedule.
BACKGROUND AND OBJECTIVES: Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. MATERIAL AND METHODS:Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014-2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. RESULTS: 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p<0.001). Anti-TNF drugs were associated with better response and rituximab with the worst (79.2% vs 55.0% for final seropositivity against antigen A, p=0.020). Vaccine response in the rituximab group tended to improve when the interval between the drug administration and the vaccination was at least 12 weeks (seropositivity rate 80.0% in those with the longer interval vs 25.0% in the other group, p=0.054). CONCLUSIONS: Among the patients on biological therapy vaccinated against influenza, anti-TNF therapy was identified as a predictive factor of final seropositivity. Rituximab presented a lower rate of final seropositivity, which could be increased with an accurate administration schedule.