RESEARCH - Humoral responses after influenza vaccination are severely reduced in RA patients treated with rituximab

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Arthritis Rheum. 2009 Dec 28;62(1):75-81.

Humoral responses after influenza vaccination are severely reduced in

patients with rheumatoid arthritis treated with rituximab.

van Assen S, Holvast A, Benne CA, Posthumus MD, van Leeuwen MA,

Voskuyl AE, Blom M, Risselada AP, de Haan A, Westra J, Kallenberg CG,

Bijl M.

University Medical Center Groningen, Groningen, The Netherlands.

OBJECTIVE: For patients with rheumatoid arthritis (RA), yearly

influenza vaccination is recommended. However, its efficacy in

patients treated with rituximab is unknown. The objectives of this

study were to investigate the efficacy of influenza vaccination in RA

patients treated with rituximab and to investigate the duration of the

possible suppression of the humoral immune response following

rituximab treatment. We also undertook to assess the safety of

influenza vaccination and the effects of previous influenza

vaccination.

METHODS: Trivalent influenza subunit vaccine was administered to 23 RA

patients who had received rituximab (4-8 weeks after rituximab for 11

patients [the early rituximab subgroup] and 6-10 months after

rituximab for 12 patients [the late rituximab subgroup]), 20 RA

patients receiving methotrexate (MTX), and 29 healthy controls. Levels

of antibodies against the 3 vaccine strains were measured before and

28 days after vaccination using hemagglutination inhibition assay. The

Disease Activity Score in 28 joints (DAS28) was used to assess RA

activity.

RESULTS: Following vaccination, geometric mean titers (GMTs) of

antiinfluenza antibodies significantly increased for all influenza

strains in the MTX-treated group and in healthy controls, but for no

strains in the rituximab-treated group. However, in the late rituximab

subgroup, a rise in GMT for the A/H3N2 and A/H1N1 strains was

demonstrated, in the absence of a repopulation of CD19+ cells at the

time of vaccination. Seroconversion and seroprotection occurred less

often in the rituximab-treated group than in the MTX-treated group for

the A/H3N2 and A/H1N1 strains, while seroprotection occurred less

often in the rituximab-treated group than in the healthy controls for

the A/H1N1 strain. Compared with unvaccinated patients in the

rituximab-treated group, previously vaccinated patients in the

rituximab-treated group had higher pre- and postvaccination GMTs for

the A/H1N1 strain. The DAS28 did not change after vaccination.

CONCLUSION: Rituximab reduces humoral responses following influenza

vaccination in RA patients, with a modestly restored response 6-10

months after rituximab administration. Previous influenza vaccination

in rituximab-treated patients increases pre- and postvaccination

titers. RA activity was not influenced.

PMID: 20039396

http://www.ncbi.nlm.nih.gov/pubmed/20039396

Not an MD