Session Type: Abstract Submissions (ACR)
Background/Purpose: To determine the influence of disease activity without the effect of drugs in pandemic 2009 influenza A (H1N1) vaccine immune response in untreated systemic lupus erythematosus (SLE).
Methods: SLE patients without therapy [n=75] and healthy controls [n=170] were vaccinated with a single dose of a nonadjuvanted A/California/7/2009/H1N1 vaccine. Clinical and laboratorial data, including disease activity scores (SLEDAI), were monitored prevaccination and 21 days postvaccination. Anti-H1N1 titres, percentages of seroprotection (SP), and seroconversion (SC) were evaluated.
Results: After immunisation, untreated patients with SLEDAI=0 [n=22] had comparable SP (86.4%; 95%CI 72.0-100.7; p=1.0) and SC (86.4%; 95%CI 72.0-100.7; p=0.57) to controls whereas untreated patients with any level of disease activity (SLEDAI>0) [n=53] had lower SP (69.8%; 95%CI 57.4-84.4 vs. 84.1%; 95%CI 78.6-89.6; p=0.028) and SC rates (66.0%; 95%CI 53.2-78.7 vs. 80.0%; 95%CI 74.0-86.0; p=0.041) compared to controls. Reinforcing this finding, a significant lower SP (37.5%; 95%CI 13.8-61.2 vs. 79.6%; 95%CI 69.3-89.9; p=0.008) and SC rates (37.5%; 95%CI 13.8-61.2 vs. 77.9%; 95%CI 67.3-88.5; p=0.016) were observed in untreated SLE patients with SLEDAI>6 [n=16] compared with those with SLEDAI<6 [n=59], in spite of a similar mean lymphocyte count (1,260 ± 625 vs. 1,480 ± 840/mm3; p=0.33). Untreated SLE patients with low lymphocytes (<1,000/mm3) [n=21] had similar SP (61.9%; 95%CI 41.1-82.4 vs. 72.2%; 95%CI 60.2-84.1; p=0.41) and SC rates (57.1%; 95%CI 35.9-78.3 vs. 72.2%; 95%CI 60.2-84.1; p=0.27) compared to untreated SLE patients with levels within normal range (>1,000/mm3) [n=54]. SLE patients with anti-dsDNA+ [n=42] had lower postvaccine SP (59.5%; 95% CI 44.6 to 74.3 vs. 81.8%; 95% CI 68.6 to 94.9; p=0.046) and SC rates (57.1%; 95% CI 42.1 to 72.1 vs. 81.8%; 95% CI 68.6 to 94.9; p=0.027) compared to SLE patients without this antibody (anti-dsDNA-) [n=33].
Conclusion: This study provides clear evidence that SLE disease activity severely impairs pandemic influenza H1N1 vaccine immune response independent of lymphocyte counts or drugs.
E. F. Borba,
S. G. Pasoto,
A. L. Calich,
V. S. T. Viana,
M. A. Ishida,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lupus-disease-activity-severely-impairs-pandemic-influenza-ah1n1-vaccine-immune-response-in-patients-without-therapy/