Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Author(s):Show less -

Aikawa, Nadia E. ^[1] ; Campos, Lucia M. A. ^[2] ; Silva, Clovis A. ^[2] ; Carvalho, Jozelio F. ^[2] ; Saad, Carla G. S. ^[2] ; Trudes, Guilherme ^[2] ; Duarte, Alberto ^[3] ; Miraglia, Joao L. ^[4] ; Timenetsky, Maria do Carmo S. ^[5] ; Viana, Vilma S. T. ^[2] ; Franca, Ivan L. A. ^[2] ; Bonfa, Eloisa ^[2] ; Pereira, Rosa M. R. ^[6]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Pediat Rheumatol Unit, Div Rheumatol, BR-01246903 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Pediat Rheumatol Unit, Fac Med, Hosp Clin, BR-01246903 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Hosp Clin, Fac Med, Div Cent Lab, BR-01246903 Sao Paulo - Brazil

^[4] Fundacao Butantan, Inst Butantan, Sao Paulo - Brazil

^[5] Univ Sao Paulo, Inst Adolfo Lutz, Fac Med, Hosp Clin, BR-01246903 Sao Paulo - Brazil

^[6] Univ Sao Paulo, Fac Med, Disciplina Reumatol, Div Infect Dis, BR-01246903 Sao Paulo - Brazil

• Document type: Journal article
• Source: JOURNAL OF RHEUMATOLOGY; v. 39, n. 1, p. 167-173, JAN 2012.
• Web of Science Citations: 34

Abstract

Objective. To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population. Method's. A total of 237 patients with juvenile ARD {[}juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated. Results. Age was comparable in patients and controls (14.8 +/- 3.0 vs 14.6 +/- 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant. Conclusion. This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644. (First Release Nov 15 2011; J Rheumatol 2012;39:167-73; doi:10.3899/jrheum.110721) (AU)

• FAPESP's process: 10/10749-0 - Anti-influenza H1N1/2009 vaccine in autoimmune rheumatic diseases patients
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Regular Research Grants