RESEARCH - The effect of Remicade and timing of vaccination on the humoral response to influenza vaccination in RA and AS

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Semin Arthritis Rheum. 2009 Feb 24.

The Effect of Infliximab and Timing of Vaccination on the Humoral

Response to Influenza Vaccination in Patients with Rheumatoid

Arthritis and Ankylosing Spondylitis.

Elkayam O, Bashkin A, Mandelboim M, Litinsky I, Comaheshter D,

Levartovsky D, Mendelson E, Wigler I, Caspi D, Paran D.

Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Sackler

Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department

of Internal Medicine " F " , Tel-Aviv Sourasky Medical Center, Sackler

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

OBJECTIVES: To assess the effect of the timing of vaccination in

relation to administration of infliximab on the efficacy and safety of

influenza vaccine in patients with rheumatoid arthritis (RA) and

ankylosing spondylitis (AS).

METHODS: The study population comprised 38 patients treated with

infliximab at a mean dosage of 3 mg/kg (20 RA patients; 18 AS

patients; 23 RA controls (treated with disease modifying antirheumatic

drugs other than anti-tumor necrosis factor-alpha; and 17 healthy

controls). Split-virion inactivated vaccine containing 15 mug

hemagglutinin/dose of each of A/New Caledionan/20/1999 (H1N1),

A/Wisconsin/67/2005 (H3N2), and B/Malaysia/2506/2004 (M) was used.

Patients treated with infliximab were divided into 2 groups: 22 were

vaccinated on the day of administration of infliximab, while 16

received the vaccine 3 weeks after infliximab. Baseline and 4- to

6-week clinical assessment of disease activity included erythrocyte

sedimentation rate and C-reactive protein for all patients, the

28-joint disease-activity score for RA patients, and Bath Ankylosing

Spondylitis Disease Activity Index for AS patients. Hemagglutination

inhibition (HI) antibodies were tested by a standard World Health

Organization procedure. Response was defined as >/=4-fold rise in HI

antibodies 4 to 6 weeks after vaccination, or seroconversion in

patients with a nonprotective baseline level of antibodies (<1/40).

Geometric mean titers (GMT) were calculated to assess the immunity of

the whole group.

RESULTS: At baseline, RA patients and controls had similar occurrence

of protective levels of HI antibodies and GMT, while AS patients had

lower levels reflecting lower rates of previous vaccination. Four

weeks after vaccination, a significant and similar increase in GMT for

each antigen was observed in all groups (P < 0.004) except in the

RA-infliximab group, vaccinated 3 weeks after administration of

infliximab, in whom the increase in GMT was not significant for H1N1

(P = 0.12) and H3 (P = 0.06). AS patients demonstrated an increase in

GMT, independently of the time of vaccination. The percentage of

responders was similar in all groups. The response was not affected by

variables such as age, gender, methotrexate, or prednisone use.

Parameters of disease activity remained unchanged. No adverse effects

other than injection site pain were recorded.

CONCLUSIONS: Influenza virus vaccine generated a good humoral response

in RA and AS patients treated with infliximab.

PMID: 19246078

http://www.ncbi.nlm.nih.gov/pubmed/19246078

Not an MD