Background/Purpose:

Several studies suggest that the efficacy of influenza vaccination may be decreased in systemic lupus erythematosus (SLE). We performed a meta-analysis to assess systematically the immunogenicity of influenza vaccination in SLE, comparatively to healthy subjects.

Methods:

All studies published until February 2013, comparing the immunogenicity of influenza vaccination in SLE comparatively to healthy subjects were identified from the MEDLINE, Cochrane and EMBASE databases and included in our meta-analysis. The immunogenicity was evaluated using the proportion of subjects with influenza antibody titers ≥1:40 (seroprotection rate) and the proportion of subjects with either a prevaccination hemagglutination-inhibiting titer <1:10 and a postvaccination titer ≥1:40 or a prevaccination titer ≥1:10 and an increase in the titer by a factor of 4 or more (seroconversion rate). Pooled effect estimates were obtained using a random-effects model.

Results:

Of 146 citations retrieved, 16 primary studies including 1010 SLE patients and 578 healthy controls met inclusion criteria. Pooled analysis revealed significantly decreased immunogenicity of H1N1 influenza vaccine in SLE patients compared to healthy controls for both seroprotection rates (Odd Ratio, OR:  0.34 [95% confidence interval, 95%CI: 0.21 – 0.55]) and seroconversion rates (OR: 0.34 [95%CI: 0.21 – 0.56]) with significant statistical heterogeneity for seroconversion (T² = 0.37; p = 0.01; I² = 0.54). Our meta-analysis also reveals significantly decreased seroprotection rates with H3N2 (OR: 0.34 [95%CI: 0.18 – 0.66]) and B (OR: 0.40 [95%CI: 0.22 – 0.73]) influenza vaccines and non-significantly decreased seroconversion rates for H3N2 (OR: 0.55 [95%CI: 0.21 – 1.45]) and B (OR: 0.44 [95%CI: 0.19 – 1.01]) influenza vaccines. Subgroup analyses considering only SLE patients without corticosteroids and immunosuppressors (n=209) revealed non significantly decreased seroprotection rate (OR: 0.60 [95%CI: 0.35 – 1.01]) and decreased seroconversion rate (OR: 0.64 [95%CI: 0.42 – 0.98]) compared with healthy controls (n=226).

Conclusion:

Our meta-analysis demonstrates significantly decreased immunogenicity of influenza vaccines in SLE compared to healthy patients. Subgroup analysis suggests that decreased immunogenicity may be independent of immunosuppressive treatments. Specific vaccination schemes, -such as the use of a second injection or the use of adjuvanted vaccines-, should be evaluated in SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-influenza-vaccination-is-strongly-decreased-in-systemic-lupus-erythematosus-a-meta-analysis-of-literature-data/