RESEARCH - Vaccination against influenza in patients with RA: effect of rituximab on the humoral response

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Ann Rheum Dis. 2008 Jul;67(7):937-41. Epub 2007 Nov 2.

Vaccination against influenza in patients with rheumatoid arthritis:

the effect of rituximab on the humoral response.

Oren S, Mandelboim M, Braun-Moscovici Y, Paran D, Ablin J, Litinsky I,

Comaneshter D, Levartovsky D, Mendelson E, Azar R, Wigler I,

Balbir-Gurman A, Caspi D, Elkayam O.

Department of Rheumatology, Tel Aviv Sourasky Medical Centre, Sackler

Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.

OBJECTIVE: To assess the effect of rituximab on the efficacy and

safety of influenza virus vaccine in patients with rheumatoid

arthritis (RA).

METHODS: The study group comprised patients with RA treated with

conventional disease-modifying drugs with or without rituximab.

Split-virion inactivated vaccine containing 15 microg

haemagglutinin/dose of B/Shanghai/361/02 (SHAN), A/New

Caledonian/20/99 (NC) (H1N1) and A/California/7/04 (CAL) (H3N2) was

used. Disease activity was assessed by the number of tender and

swollen joints, duration of morning stiffness and evaluation of pain

on the day of vaccination and 4 weeks later. CD19-positive cell levels

were assessed in rituximab-treated patients. Haemagglutination

inhibition (HI) antibodies were tested and response was defined as a

greater than fourfold rise 4 weeks after vaccination or seroconversion

in patients with a non-protective baseline level of antibodies

(<1/40). Geometric mean titres (GMT) were calculated in all subjects.

RESULTS: The participants were divided into three groups: RA (n = 29,

aged 64 (12) years), rituximab-treated RA (n = 14, aged 53 (15) years)

and healthy controls (n = 21, aged 58 (15) years). All baseline

protective levels of HI antibodies and GMT were similar. Four weeks

after vaccination, there was a significant increase in GMT for NC and

CAL antigens in all subjects, but not for the SHAN antigen in the

rituximab group. In rituximab-treated patients, the percentage of

responders was low for all three antigens tested, achieving

statistical significance for the CAL antigen. Measures of disease

activity remained unchanged.

CONCLUSION: Influenza virus vaccine generated a humoral response in

all study patients with RA and controls. Although the response was

significantly lower among rituximab-treated patients, treatment with

rituximab does not preclude administration of vaccination against

influenza.

PMID: 17981914

http://www.ncbi.nlm.nih.gov/pubmed/17981914

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