Background/Purpose: Autoimmune, autoinflammatory mechanism and drugs used in treatment increase the risk of liver disease in patients with chronic rheumatic diseases. Hepatitis A vaccine is a highly effective vaccine that prevents both the formation and spread of clinical hepatitis. In childhood chronic rheumatic diseases, vaccination is of great importance. The risk of various infections increases with the immunosuppressive effect of both the disease and the drugs.Therefore, vaccination of these diseases is of high importance for the prevention of infectious diseases. Studies on the efficacy and safety of vaccines in autoimmune and autoinflammatory diseases are limited. The aim of this study was to investigate the efficacy and safety of hepatitis A vaccine in patients with autoinflammatory disease on anti-interleukin 1 and 6 treatment.

Methods: This study was carried out in Pediatric Rheumatology outpatient clinic and general paediatric outpatient clinic. A total of 39 patients with autoinflammatory diseases on anti IL-1 and IL-6 therapy were initially evaluated but 25 of them were excluded due to anti-HAV IgG positivity. At the end, 24 patients with  autoinflammatory diseases on anti IL-1, anti IL-6 therapy  and 39 healthy participants who were seronegative for hepatitis A received two doses of the hepatitis A vaccine in a 0 and 6 month schedule. Hepatitis A virus (HAV) IgG antibodies were measured before vaccination and one month after last dose of the vaccine. Anti-HAV IgG titer as S/ CO;1.1, IU/L was considered positive and protective.

Results: Total 24 patients with autoinflammatory condition and 39 healthy controls  were included in the study.  Among patients with diagnosis of autoinflammatory disease, 19 were Systemic juvenile idiopathic arthritis (SJİA) and 5 were Cryopyrin-associated periodic syndromes (CAPS) patients. The mean age was 14.1±3.7 and 12.2±3.3 years respectively. Canakinumab was used in 15 (62.5%) and tocilizumab in 9 (37.5%) all patients. Among all SJİA patients, 10 (52.6%) were treated with canakinumab and 9(47.4%) were treated with tocilizumab. All patients with CAPS (n: 5) were using canakinumab. Among SJIA cases, 15(75%) were also using methotrexate and 14(70%) prednisolone.  Anti-HAV IgG concentrations were measured one month after the last dose of hepatitis A vaccine. There was statistically significant difference between patients with autoinflammatory condition and healthy controls regarding the anti-HAV IgG titer (mean 5.3±1.5 IU/L) versus (10.5±7 IU/L) p< 0.05. The rate of anti-HAV IgG seropositivity (cut-off 1.1 IU/L) in autoinflammatory disease (24/24 (100%) was significantly different comparing to healthy controls (33/39, 84.6%) (p=0.04). There was no disease flare of disease nor the adverse event detected in any patients after vaccination. Conclusion: Anti-HAV IgG seroconversion was detected in patients with autoinflammatory disease on anti-IL1 and anti – IL6 therapy 1 month after the last dose of hepatitis A vaccine. The response to vaccine did not differ between healthy children and patients with autoinflammatory disease under canakinumab and tocilizumab. In this study hepatitis A vaccine was found to be safe in autoinflammatory diseases with canakinumab and tocilizumab treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hepatitis-a-virus-vaccination-in-autoinflammatory-diseases-under-canakinumab-and-tocilizumab-treatment/