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Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease

Identifieur interne : 001C62 ( Main/Exploration ); précédent : 001C61; suivant : 001C63

Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease

Auteurs : A. Holvast [Pays-Bas] ; A. Huckriede [Pays-Bas] ; J. Wilschut [Pays-Bas] ; G. Horst [Pays-Bas] ; J J C. De Vries [Pays-Bas] ; C A Benne [Pays-Bas] ; C G M. Kallenberg [Pays-Bas] ; M. Bijl [Pays-Bas]

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RBID : ISTEX:3E5E528679D6A4F1B868379119089A10DF335CF5

English descriptors

Abstract

Objective: to assess the safety and efficacy of influenza vaccination in patients with systemic lupus erythematosus (SLE), and to evaluate the influence of immunosuppressive drugs on the immune response. Methods: SLE patients (n = 56) and healthy controls (n = 18) were studied. All patients had quiescent disease (SLE disease activity index ⩽5). Four patient groups were defined on the basis of their drug use: (1) no drug treatment; (2) hydroxychloroquine treatment; (3) azathioprine treatment; (4) prednisone treatment. Participants received trivalent influenza subunit vaccine during October/November 2003. Disease activity scores and side effects were recorded. Antibody titres against influenza virus were measured before and 30 days after vaccination using the haemagglutination inhibition assay. Results: Influenza vaccination did not result in changes in disease activity and was well tolerated. SLE patients had fewer seroconversions or fourfold titre rises for A/H1N1 (p<0.001) and A/H3N2 (p<0.001) than healthy controls, while for B/Hong Kong the difference was of borderline significance (p = 0.051). With regard to immunosuppressive treatment, fewer SLE patients using azathioprine developed fourfold titre rises against A/H3N2 (p = 0.041), and fewer achieved titres of ⩾40 against A/H3N2 (p = 0.030) compared with the other patient groups. Conclusions: Influenza vaccination in SLE patients with quiescent disease is safe but is less effective than in controls. Use of azathioprine was associated with a trend to decreased vaccination efficacy.

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DOI: 10.1136/ard.2005.043943


Affiliations:


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<term>GMT, geometric mean titre</term>
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<term>SLEDAI, SLE disease activity index</term>
<term>VAS, visual analogue score</term>
<term>efficacy</term>
<term>influenza vaccination</term>
<term>safety</term>
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<term>Antibody response</term>
<term>Azathioprine</term>
<term>Azathioprine group</term>
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<term>Disease activity</term>
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<term>Healthy controls</term>
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<term>Humoral</term>
<term>Hydroxychloroquine</term>
<term>Immune</term>
<term>Immune response</term>
<term>Immunocompromised patients</term>
<term>Immunogenicity</term>
<term>Immunosuppressive</term>
<term>Immunosuppressive drug treatment</term>
<term>Immunosuppressive drugs</term>
<term>Influenza</term>
<term>Influenza immunization</term>
<term>Influenza vaccination</term>
<term>Influenza vaccine</term>
<term>Lower immunogenicity</term>
<term>Lupus</term>
<term>More patients</term>
<term>Other patient groups</term>
<term>Patient groups</term>
<term>Pneumococcal vaccination</term>
<term>Previous season</term>
<term>Quiescent disease</term>
<term>Seroconversions</term>
<term>Side effects</term>
<term>Significant effect</term>
<term>Sledai</term>
<term>Solvay pharmaceuticals</term>
<term>Systemic</term>
<term>Systemic lupus erythematosus</term>
<term>Titre</term>
<term>Vaccination</term>
<term>Vaccination efficacy</term>
<term>Vaccination kong</term>
<term>Vaccine</term>
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<div type="abstract" xml:lang="en">Objective: to assess the safety and efficacy of influenza vaccination in patients with systemic lupus erythematosus (SLE), and to evaluate the influence of immunosuppressive drugs on the immune response. Methods: SLE patients (n = 56) and healthy controls (n = 18) were studied. All patients had quiescent disease (SLE disease activity index ⩽5). Four patient groups were defined on the basis of their drug use: (1) no drug treatment; (2) hydroxychloroquine treatment; (3) azathioprine treatment; (4) prednisone treatment. Participants received trivalent influenza subunit vaccine during October/November 2003. Disease activity scores and side effects were recorded. Antibody titres against influenza virus were measured before and 30 days after vaccination using the haemagglutination inhibition assay. Results: Influenza vaccination did not result in changes in disease activity and was well tolerated. SLE patients had fewer seroconversions or fourfold titre rises for A/H1N1 (p<0.001) and A/H3N2 (p<0.001) than healthy controls, while for B/Hong Kong the difference was of borderline significance (p = 0.051). With regard to immunosuppressive treatment, fewer SLE patients using azathioprine developed fourfold titre rises against A/H3N2 (p = 0.041), and fewer achieved titres of ⩾40 against A/H3N2 (p = 0.030) compared with the other patient groups. Conclusions: Influenza vaccination in SLE patients with quiescent disease is safe but is less effective than in controls. Use of azathioprine was associated with a trend to decreased vaccination efficacy.</div>
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