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Influenza A/H1N1 vaccination of patients with SLE: can antimalarial drugs restore diminished response under immunosuppressive therapy?

2012; Oxford University Press; Volume: 51; Issue: 6 Linguagem: Inglês

10.1093/rheumatology/ker427

1462-0332

Eduardo Ferreira Borba, Carla Gonçalves Schahin Saad, Sandra Gofinet Pasoto, Ana Luísa Calich, Nádia Emi Aikawa, Ana Cristina de Medeiros Ribeiro, Júlio César Bertacini de Moraes, Elaine Pires Leon, Leonora Pires Costa, Lissiane Karine Noronha Guedes, Clóvis A. Silva, Célio Roberto Gonçalves, Ricardo Fuller, S. A. Oliveira, María Akíko Ishida, Alexander Roberto Precioso, Eloísa Bonfá,

Monoclonal and Polyclonal Antibodies Research

Objective. To assess the efficacy and safety of pandemic 2009 influenza A (H1N1) in SLE under different therapeutic regimens. Methods. A total of 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a non-adjuvanted preparation. According to current therapy, patients were initially classified as SLE No Therapy ( n = 75) and SLE with Therapy ( n = 480). Subsequent evaluations included groups under monotherapy: chloroquine (CQ) ( n = 105), prednisone (PRED) ≥20 mg ( n = 76), immunosuppressor (IS) ( n = 95) and those with a combination of these drugs. Anti-H1N1 titres and seroconversion (SC) rate were evaluated at entry and 21 days post-vaccination. Results. The SLE with Therapy group had lower SC compared with healthy controls (59.0 vs 80.0%; P < 0.0001), whereas the SLE No Therapy group had equivalent SC (72 vs 80.0%; P = 0.18) compared with healthy controls. Further comparison revealed that the SC of SLE No Therapy (72%) was similar to the CQ group (69.5%; P = 0.75), but it was significantly reduced in PRED ≥20 mg (53.9%; P = 0.028), IS (55.7%; P = 0.035) and PRED ≥20 mg + IS (45.4%; P = 0.038). The concomitant use of CQ in each of these later regimens was associated with SC responses comparable with SLE No Therapy group (72%): PRED ≥20 mg + CQ (71.4%; P = 1.00), IS + CQ (65.2%; P = 0.54) and PRED ≥20 mg + IS + CQ (57.4%; P = 0.09). Conclusion. Pandemic influenza A H1N1/2009 vaccine response is diminished in SLE under immunosuppressive therapy and antimalarials seems to restore this immunogenicity. Trial registration.www.clinicaltrials.gov , NCT01151644.