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Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response.
Ann Rheum Dis. 2008 Jul; 67(7):937-41.AR

Abstract

OBJECTIVE

To assess the effect of rituximab on the efficacy and safety of influenza virus vaccine in patients with rheumatoid arthritis (RA).

METHODS

The study group comprised patients with RA treated with conventional disease-modifying drugs with or without rituximab. Split-virion inactivated vaccine containing 15 microg haemagglutinin/dose of B/Shanghai/361/02 (SHAN), A/New Caledonian/20/99 (NC) (H1N1) and A/California/7/04 (CAL) (H3N2) was used. Disease activity was assessed by the number of tender and swollen joints, duration of morning stiffness and evaluation of pain on the day of vaccination and 4 weeks later. CD19-positive cell levels were assessed in rituximab-treated patients. Haemagglutination inhibition (HI) antibodies were tested and response was defined as a greater than fourfold rise 4 weeks after vaccination or seroconversion in patients with a non-protective baseline level of antibodies (<1/40). Geometric mean titres (GMT) were calculated in all subjects.

RESULTS

The participants were divided into three groups: RA (n = 29, aged 64 (12) years), rituximab-treated RA (n = 14, aged 53 (15) years) and healthy controls (n = 21, aged 58 (15) years). All baseline protective levels of HI antibodies and GMT were similar. Four weeks after vaccination, there was a significant increase in GMT for NC and CAL antigens in all subjects, but not for the SHAN antigen in the rituximab group. In rituximab-treated patients, the percentage of responders was low for all three antigens tested, achieving statistical significance for the CAL antigen. Measures of disease activity remained unchanged.

CONCLUSION

Influenza virus vaccine generated a humoral response in all study patients with RA and controls. Although the response was significantly lower among rituximab-treated patients, treatment with rituximab does not preclude administration of vaccination against influenza.

Authors+Show Affiliations

Oren S
Department of Rheumatology, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
Mandelboim M
No affiliation info available
Braun-Moscovici Y
No affiliation info available
Paran D
No affiliation info available
Ablin J
No affiliation info available
Litinsky I
No affiliation info available
Comaneshter D
No affiliation info available
Levartovsky D
No affiliation info available
Mendelson E
No affiliation info available
Azar R
No affiliation info available
Wigler I
No affiliation info available
Balbir-Gurman A
No affiliation info available
Caspi D
No affiliation info available
Elkayam O
No affiliation info available

MeSH

AdultAgedAntibodies, MonoclonalAntibodies, Monoclonal, Murine-DerivedAntibodies, ViralAntirheumatic AgentsArthritis, RheumatoidFemaleHemagglutination Inhibition TestsHumansInfluenza A virusInfluenza B virusInfluenza VaccinesInfluenza, HumanMaleMiddle AgedRituximabSeverity of Illness IndexVaccination

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

17981914

Citation

Oren, S, et al. "Vaccination Against Influenza in Patients With Rheumatoid Arthritis: the Effect of Rituximab On the Humoral Response." Annals of the Rheumatic Diseases, vol. 67, no. 7, 2008, pp. 937-41.
Oren S, Mandelboim M, Braun-Moscovici Y, et al. Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response. Ann Rheum Dis. 2008;67(7):937-41.
Oren, S., Mandelboim, M., Braun-Moscovici, Y., Paran, D., Ablin, J., Litinsky, I., Comaneshter, D., Levartovsky, D., Mendelson, E., Azar, R., Wigler, I., Balbir-Gurman, A., Caspi, D., & Elkayam, O. (2008). Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response. Annals of the Rheumatic Diseases, 67(7), 937-41.
Oren S, et al. Vaccination Against Influenza in Patients With Rheumatoid Arthritis: the Effect of Rituximab On the Humoral Response. Ann Rheum Dis. 2008;67(7):937-41. PubMed PMID: 17981914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response. AU - Oren,S, AU - Mandelboim,M, AU - Braun-Moscovici,Y, AU - Paran,D, AU - Ablin,J, AU - Litinsky,I, AU - Comaneshter,D, AU - Levartovsky,D, AU - Mendelson,E, AU - Azar,R, AU - Wigler,I, AU - Balbir-Gurman,A, AU - Caspi,D, AU - Elkayam,O, Y1 - 2007/11/02/ PY - 2007/11/6/pubmed PY - 2008/8/6/medline PY - 2007/11/6/entrez SP - 937 EP - 41 JF - Annals of the rheumatic diseases JO - Ann Rheum Dis VL - 67 IS - 7 N2 - OBJECTIVE: To assess the effect of rituximab on the efficacy and safety of influenza virus vaccine in patients with rheumatoid arthritis (RA). METHODS: The study group comprised patients with RA treated with conventional disease-modifying drugs with or without rituximab. Split-virion inactivated vaccine containing 15 microg haemagglutinin/dose of B/Shanghai/361/02 (SHAN), A/New Caledonian/20/99 (NC) (H1N1) and A/California/7/04 (CAL) (H3N2) was used. Disease activity was assessed by the number of tender and swollen joints, duration of morning stiffness and evaluation of pain on the day of vaccination and 4 weeks later. CD19-positive cell levels were assessed in rituximab-treated patients. Haemagglutination inhibition (HI) antibodies were tested and response was defined as a greater than fourfold rise 4 weeks after vaccination or seroconversion in patients with a non-protective baseline level of antibodies (<1/40). Geometric mean titres (GMT) were calculated in all subjects. RESULTS: The participants were divided into three groups: RA (n = 29, aged 64 (12) years), rituximab-treated RA (n = 14, aged 53 (15) years) and healthy controls (n = 21, aged 58 (15) years). All baseline protective levels of HI antibodies and GMT were similar. Four weeks after vaccination, there was a significant increase in GMT for NC and CAL antigens in all subjects, but not for the SHAN antigen in the rituximab group. In rituximab-treated patients, the percentage of responders was low for all three antigens tested, achieving statistical significance for the CAL antigen. Measures of disease activity remained unchanged. CONCLUSION: Influenza virus vaccine generated a humoral response in all study patients with RA and controls. Although the response was significantly lower among rituximab-treated patients, treatment with rituximab does not preclude administration of vaccination against influenza. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/17981914/Vaccination_against_influenza_in_patients_with_rheumatoid_arthritis:_the_effect_of_rituximab_on_the_humoral_response_ DB - PRIME DP - Unbound Medicine ER -