The effect of infliximab and timing of vaccination on the humoral response to influenza vaccination in patients with rheumatoid arthritis and ankylosing spondylitis
Elkayam O et al. – Study reports that influenza virus vaccine generated a good humoral response in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients treated with infliximab.Methods- An assessment of the effect of the timing of vaccination in relation to administration of infliximab on the efficacy and safety of influenza vaccine in pts with RA and AS
- 38 pts treated with infliximab at a mean dosage of 3 mg/kg:
- 20 RA pts; 18 AS pts
- 23 RA controls treated with DMARDs other than anti-TNF-α and
- 17 healthy controls
- Pts treated with infliximab were divided into 2 groups:
- 22 were vaccinated on the day of administration of infliximab
- 16 received the vaccine 3 wks after infliximab
- Baseline and 4- to 6-wk clinical assessment of disease activity included ESR and CRP for all pts, the DAS28 for RA pts, and BASDAI for AS pts
- Hemagglutination inhibition (HI) Abs were tested by a standard WHO procedure
- Response was defined as ≥4-fold rise in HI Abs 4 to 6 wks after vaccination, or seroconversion in pts with a nonprotective baseline level of Abs
- Geometric mean titers (GMT) were calculated to assess the immunity of the whole group
Results- At baseline, RA pts and controls had similar occurrence of protective levels of HI Abs and GMT
- AS pts had lower levels reflecting lower rates of previous vaccination
- 4 wks after vaccination, a similar increase in GMT for each antigen was observed in all groups except in the RA-infliximab group, vaccinated 3 wks after admin. of infliximab, in whom the increase in GMT was not significant for H1N1
- AS pts demonstrated an increase in GMT, independently of the time of vaccination
- The percentage of responders was similar in all groups
- Response was not affected by variables such as age, gender, MTX, or prednisone use
- Parameters of disease activity remained unchanged
- No AEs other than injection site pain were recorded
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