Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: At present, annual vaccination against influenza is recommended for rheumatoid arthritis (RA) patients. However, whether humoral responses to influenza vaccine are impaired in RA patients treated with biological agents remains controversial. This study aimed to compare seroresponse rates after influenza vaccination in RA patients treated with five biological agents.
Methods: Trivalent influenza subunit vaccines containing A/H1N1, A/H3N2, and B-1 were administered subcutaneously once to 64 RA patients treated with methotrexate (MTX, control, n = 15), infliximab (IFX, n = 12), etanercept (ETN, n = 11), adalimumab (ADA, n = 3), tocilizumab (TCZ, n = 12), or abatacept (ABT, n = 11). We measured antibody titers using hemagglutination inhibition (HI) test at baseline and 4–8 weeks after vaccination. The immunogenicity end points were the proportion of patients with antibody titers of 1:40 or more on HT test and the proportion of patients with either seroconversion or a significant increase in antibody titer.
Results: Table 1 shows baseline characteristics of all the 64 RA patients. Seroconversion and seropositive rates (%) after subcutaneous vaccination were 54.3 and 64.4, respectively, in MTX; 46.2 and 61.1, respectively, in IFX; 73.3 and 87.9, respectively, in ETN; 62.5 and 66.7, respectively, in ADA; 48.3 and 58.3, respectively, in TCZ; and 21.4 and 33.3, respectively, in ABT. Seronegative rates (%) were 45.7 in MTX, 53.8 in IFX, 26.7 in ETN, 37.5 in ADA, 51.7 in TCZ, and 78.6 in ABT (Table 2). Both the decrease in the seroresponse rate after influenza vaccination in the ABT group and increase in the seropositive rate in the ETN group were significant compared with those in the MTX control group (P < 0.01) (Table 2). Of the 64 RA patients, only one patient in the MTX group was infected by influenza during this season.
Conclusion: RA patients treated with ABT exhibited compromised immune responses to influenza vaccine compared with those treated with MTX or other biological agents. Therefore, RA patients treated with ABT would benefit from repeated influenza vaccinations.
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Table 1. Baseline characteristics of 64 RA patients |
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|
Agents |
Number of patients |
Males (%) |
Mean age ± SD (years) |
PSL rate (%) |
Mean usage of PSL ± SD (mg/day) |
|
MTX |
15 |
6.7 |
68.3 ± 9.8 |
33.3 |
4.1 ± 2.2 |
|
IFX |
12 |
16.7 |
61.6 ± 10.8 |
66.7 |
3.9 ± 2.1 |
|
ETN |
11 |
9.1 |
58.6 ± 15.6 |
54.5 |
3.5 ± 2.4 |
|
ADA |
3 |
33.3 |
69.3 ± 7.0 |
33.3 |
5.0 ± 0.0 |
|
TCZ |
12 |
25.0 |
67.7 ± 12.8 |
58.3 |
3.6 ± 1.7 |
|
ABT |
11 |
27.3 |
62.0 ± 9.8 |
81.8 |
3.8 ± 2.8 |
|
RA, rheumatoid arthritis; SD, standard deviation; PSL, prednisolone; MTX, methotrexate; IFX, infliximab; ETN, etanercept; ADA, adalimumab; TCZ, tocilizumab; ABT, abatacept
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Table 2. Seroresponse rates to influenza vaccination in 64 RA patients treated with MTX or five biological agents (192 vaccines)
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Agents |
Number of vaccinations |
Seroconversion (%) |
Seropositive (%) |
Seronegative (%) |
|
MTX |
45 |
54.3 |
64.4 |
45.7 |
|
IFX |
36 |
46.2 |
61.1 |
53.8 |
|
ETN |
33 |
73.3 |
87.9** |
26.7 |
|
ADA |
9 |
62.5 |
66.7 |
37.5 |
|
TCZ |
36 |
48.3 |
58.3 |
51.7 |
|
ABT |
33 |
21.4** |
33.3** |
78.6** |
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**significant difference from MTX (control). **: P < 0.01. RA, rheumatoid arthritis; MTX, methotrexate; IFX, infliximab; ETN, etanercept; ADA, adalimumab; TCZ, tocilizumab; ABT, abatacept
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Disclosure:
M. Hayashi,
None;
T. Kojima,
None;
N. Ishiguro,
Abbott Japan, Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd.,
2,
Abbott Japan, Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma, Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd.,
8;
T. Kobayakawa,
None;
T. Kanamono,
Santen Pharmaceutical,
2.
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