TNF blockers show distinct patterns of immune response to the pandemic influenza A H1N1 vaccine in inflammatory arthritis patients

Author(s):Show less -

Avelino Franca, Ivan Leonardo ^[1] ; Medeiros Ribeiro, Ana Cristina ; Aikawa, Nadia Emi ^[2] ; Schain Saad, Carla Goncalves ; Bertacine Moraes, Julio Cesar ; Goldstein-Schainberg, Claudia ; Magalhaes Laurindo, Ieda Maria ; Precioso, Alexander Roberto ^[3] ; Ishida, Maria Akiko ^[4] ; Christovam Sartori, Ana Marli ^[1] ; Silva, Clovis Artur ^[2] ; Bonfa, Eloisa ^[5]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Div Infect Dis, BR-05403010 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Pediat Rheumatol Unit, BR-05403010 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Inst Butantan, BR-05403010 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Fac Med, Inst Adolfo Lutz, BR-05403010 Sao Paulo - Brazil

^[5] Univ Sao Paulo, Fac Med, Disciplina Reumatol, Div Rheumatol, BR-05403010 Sao Paulo - Brazil

• Document type: Journal article
• Source: RHEUMATOLOGY; v. 51, n. 11, p. 2091-2098, NOV 2012.
• Web of Science Citations: 33

Abstract

Methods. One hundred and twenty patients (RA, n = 41; AS, n = 57; PsA, n = 22) on anti-TNF agents (monoclonal, n = 94; soluble receptor, n = 26) were compared with 116 inflammatory arthritis patients under DMARDs and 117 healthy controls. Seroprotection, seroconversion (SC), geometric mean titre, factor increase in geometric mean titre and adverse events were evaluated 21 days after vaccination. Results. After immunization, SC rates (58.2% vs 74.3%, P = 0.017) were significantly lower in SpA patients receiving anti-TNF therapy, whereas no difference was observed in RA patients receiving this therapy compared with healthy controls (P = 0.067). SpA patients receiving mAbs (infliximab/adalimumab) had a significantly lower SC rate compared with healthy controls (51.6% vs 74.3%, P = 0.002) or those on DMARDs (51.6% vs 74.7%, P = 0.005), whereas no difference was observed for patients on etanercept (86.7% vs 74.3%, P = 0.091). Further analysis of non-seroconverting and seroconverting SpA patients revealed that the former group had a higher mean age (P = 0.003), a higher frequency of anti-TNF (P = 0.031) and mAbs (P = 0.001) and a lower frequency of MTX (P = 0.028). In multivariate logistic regression, only older age (P = 0.015) and mAb treatment (P = 0.023) remained significant factors for non-SC in SpA patients. Conclusion. This study revealed a distinct disease pattern of immune response to the pandemic influenza vaccine in inflammatory arthritis patients receiving anti-TNF agents, illustrated by a reduced immunogenicity solely in SpA patients using mAbs. Trial Registration: ClinicalTrials.gov, ext-link-type={''}uri{''} xlink:href={''}www.clinicaltrials.gov{''} xmlns:xlink={''}http://www.w3.org/1999/xlink{''}>www.clinicaltrials.gov, NCT01151644. (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