Rheumatology Medical News about rheumatoid arthritis;ankylosing spondylitis;Infliximab;timing of vaccination;humoral response;influenza vaccination

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The effect of infliximab and timing of vaccination on the humoral response to influenza vaccination in patients with rheumatoid arthritis and ankylosing spondylitis
Seminars in Arthritis and Rheumatism, 06/23/09

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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