Lupus Disease Activity Severely Impairs Pandemic Influenza A/H1N1 Vaccine Immune Response in Patients without Therapy

Eduardo F. Borba¹, Sandra G. Pasoto¹, Ana L. Calich¹, Ricardo Fuller¹, Vilma S.T. Viana¹, Margareth Vendramini¹, Joao Miraglia², Maria A. Ishida³ and Eloisa Bonfa⁴, ¹Rheumatology Division, University of Sao Paulo, Sao Paulo, Brazil, ²Instituto Butantan, Fundação Butantan, São Paulo, Brazil, ³Instituto Adolfo Lutz, São Paulo, Brazil, ⁴Rheumatology Division, University of São Paulo, Sao Paulo, Brazil

Meeting: ACR/ARHP Annual Meeting 2012

Keywords: Activity score, Antibodies, immune response, prevention and systemic lupus erythematosus (SLE)

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment IV: Therapeutics

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.

Disclosure:

E. F. Borba,
None;

S. G. Pasoto,
None;

A. L. Calich,
None;

R. Fuller,
None;

V. S. T. Viana,
None;

M. Vendramini,
None;

J. Miraglia,
None;

M. A. Ishida,
None;

E. Bonfa,
None.

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