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Influenza A/H1N1 vaccination of patients with SLE: Can antimalarial drugs restore diminished response under immunosuppressive therapy?
Rheumatology, 02/03/2012
Clinical Article
Borba EF et al. – Pandemic influenza A H1N1/2009 vaccine response is diminished in SLE under immunosuppressive therapy and antimalarials seems to restore this immunogenicity.
Methods- 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a non-adjuvanted preparation
- According to current therapy, patients were initially classified as SLE No Therapy (n equals 75) and SLE with Therapy (n =480)
- Subsequent evaluations included groups under monotherapy: chloroquine (CQ) (n equals 105), prednisone (PRED) ≥20mg (n equals 76), immunosuppressor (IS) (n equals 95) and those with a combination of these drugs
- Anti-H1N1 titres and seroconversion (SC) rate were evaluated at entry and 21 days post-vaccination
- SLE with Therapy group had lower SC compared with healthy controls (59.0 vs 80.0%; P≤0.0001), whereas the SLE No Therapy group had equivalent SC (72 vs 80.0%; P equals 0.18) compared with healthy controls
- Further comparison revealed that SC of SLE No Therapy (72%) similar to CQ group (69.5%; P equals 0.75), but it was significantly reduced in PRED ≥20mg (53.9%; P equals 0.028), IS (55.7%; P equals 0.035) and PRED ≥20mg plus IS (45.4%; P equals 0.038)
- Concomitant use of CQ in each of these later regimens associated with SC responses comparable with SLE No Therapy group (72%): PRED ≥20mg plus CQ (71.4%; P equals 1.00), IS+CQ (65.2%; P equals 0.54) and PRED ≥20mg plus IS plus CQ (57.4%; P equals 0.09)
