Glucocorticoid: major factor for reduced immunogenicity of 2009 influenza A (H1N1) vaccine in patients with juvenile autoimmune rheumatic disease.

Abstract

OBJECTIVE:

To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population.

METHODS:

A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated.

RESULTS:

Age was comparable in patients and controls (14.8 ± 3.0 vs 14.6 ± 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant.

CONCLUSION:

This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644.

• Authors: Nadia E Aikawa, Lucia M A Campos, Clovis A Silva, Jozelio F Carvalho, Carla G S Saad, Guilherme Trudes, Alberto Duarte, Joao L Miraglia, Maria do Carmo S Timenetsky, Vilma S T Viana, Ivan L A França, Eloisa Bonfa, Rosa M R Pereira
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 39 Issue 1 Pg. 167-73 (Jan 2012) ISSN: 0315-162X [Print] Canada
• PMID: 22089462 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids
• Influenza Vaccines

Topics

• Adolescent
• Arthritis, Juvenile (drug therapy, immunology)
• Child
• Glucocorticoids (immunology, therapeutic use)
• Humans
• Influenza A Virus, H1N1 Subtype (immunology)
• Influenza Vaccines (immunology)
• Influenza, Human (immunology, prevention & control)
• Prospective Studies
• Rheumatic Diseases (drug therapy, immunology)
• Young Adult