EMBARGO LIFTS: Saturday, Oct. 20, 4:30 p.m. (CT)
Media Contact: Monica McDonald
Newsroom – (312) 949-8822
Office – (404) 633-3777 ext. 332
High-Dose Vaccine Enhances Production of Antibodies Against Flu in RA Patients
Newswise — CHICAGO – High-dose influenza vaccination substantially improves immune responses against influenza in adults with seropositive rheumatoid arthritis, according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #837).
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is a chronic disease that causes joint pain, stiffness, swelling and decreased movement of the joints. Small joints in the hands and feet are most commonly affected. Sometimes RA can affect your organs, such as eyes, skin or lungs. About 75 percent of RA patients are women.
RA patients have a 2.75-fold increased risk of influenza than healthy patients in the same age group, so annual flu vaccination is a high priority for them. While vaccination is an effective intervention, vaccine-induced antibody responses and flu protection in people with RA are suboptimal. A group of researchers in Montreal, Canada, conducted a study to find out if a high-dose vaccine could enhance the production of antibodies against influenza in people with RA by comparing a high-dose trivalent inactivated influenza vaccine (HD-TIV) to a standard-dose quadrivalent inactivated influenza vaccine (SD-QIV).
“The burden of influenza among people with RA is disproportionally high, and interventions to improve responses to influenza vaccination are urgently needed,” said Ines Colmegna, MD, Associate Professor, Division of Rheumatology, McGill University, and the study’s presenting author. “Strategies to optimize protection in the elderly, another vulnerable group, include the use of quadrivalent vaccines, higher antigen doses and adjuvants. In adults 65 years of age or older, the HD-TIV improved immunogenicity and protection. Like the elderly, RA patients have reduced vaccine-induced protection that limits the impact of vaccination in reducing morbidity and mortality associated with influenza.”
Their study aimed to explore whether strategies used in the elderly would also enhance protection in adults with RA. Using a treatment-stratified, randomized, modified double-blind, active-controlled trial, the researchers assessed the antibody responses to either SD-QIV (15 μg of hemagglutinin (HA) per strain) or HD-TIV (60 μg of HA per strain) in a total of 279 adult seropositive RA patients. Of this group, 140 received SD-QIV and 139 received HD-TIV. The patients were recruited from a tertiary care center during the 2016-2017 and 2017-2018 flu seasons. The mean age of the patients in the study was 61, and 80 percent were female.
Vaccination responses were relatively low in the RA patients. However, responses were consistently higher in the HD-TIV group. In logistic regression models, only vaccine dose and patient age were predictors of vaccine seroresponse. The data showed that patients that received HD-TIV were 2.8 times more likely to H3N2 seroconvert, two times more likely to B/Brisbane seroconvert and 2.3 times more likely to H1N1 seroconvert.
The study found HD-TIV substantially improves the immune response to flu vaccination for seropositive RA patients compared to a standard dose.
“Influenza vaccines are safe, effective and associated with significant reductions in the number of physician visits, hospitalizations for pneumonia or influenza, and deaths among high-risk adults,” said Dr. Colmegna. “The McGill study shows that HD-TIV provides better seroprotection against influenza in RA patients. These results together with the fact that the HD-TIV was as safe as the SD-TIV may lead to changes in practice (i.e. recommendation to use HD instead of SD influenza vaccine in RA) and inform public health decisions.”
###
About the ACR/ARHP Annual Meeting
The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR18 hashtag.
About the American College of Rheumatology
The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
Abstract #: 837
Efficacy of High-Dose Versus Standard-Dose Influenza Vaccine in Seropositive Rheumatoid Arthritis Patients
Ines Colmegna1, Mariana Useche2, Katherine Rodriguez2, Marie Hudson3, Sasha Bernatsky2, Hacene Nedjar2, Elham Rahme2 and Brian Ward2, 1Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec, Canada, Montreal, QC, 2The Research Institute of the McGill University Health Centre, Montreal, QC, 3Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC
Background/Purpose: Rheumatoid arthritis (RA) patients have 2.75 fold increased risk of influenza and influenza-related illness than age-matched healthy controls. For this reason, RA patients are a priority group for annual vaccination. Although vaccination is currently the most effective intervention against influenza and its associated complications, vaccine induced antibody responses and protection in RA are low. It is unknown if the use of a high dose vaccine (high dose trivalent inactivated influenza vaccine: HD-TIV) can improve protection over that conferred by the standard vaccine (standard dose quadrivalent inactivated influenza vaccine: SD-QIV) in RA.
Methods: We conducted a treatment-stratified, randomized, modified double-blind, active-controlled trial in adult seropositive RA patients (rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies) to assess antibody responses to either SD-QIV (15 μg of hemagglutinin (HA) per strain) or HD-TIV (60 μg of HA per strain) (NCT02936180). Subjects were recruited at a tertiary care center during the 2016–2017 (year 1) and the 2017–2018 (year 2) Northern-Hemisphere influenza seasons. They were stratified by the treatment received for 3 months prior to enrolment and during the study: DMARDs (Group 1-G1), anti-cytokine therapy (G2), anti-B-cell therapy and small molecules (G3). Seroconversion (SC) and seroprotection (SP) rates were assessed using pre- (Day 0 – D0) and post-vaccine (D28) serum hemagglutination inhibition (HI) titers. SC was defined as at least a four-fold HI antibody increase from D0. SP rate was defined as percent with HI titres ≥1:40 at D28. Vaccine strains were A/HongKong/4801/2014(H3N2), B/Brisbane/60/2008 in Y1/2 with A/California/7/2009(H1N1) in Y1 and A/Michigan/45/2015(H1N1) in Y2.
Results: A total of 279 seropositive RA patients were enrolled. 140 (50.2%) received SD-QIV and 139 (49.8%) received HD-TIV. The mean age (±SD) was 61.0±12.9 and 80% were female. According to treatment, 138 (49.5%) patients were in G1; 92 (33%) in G2 and 49 (17.6%) in G3. SP rates pre-vaccine were comparable between HD-TIV and SD-QIV groups. Overall responses to vaccination were consistently higher with the HD-TIV. SC (H3N2 22.3% vs 8.6%; B/Bris 44.6% vs 28.6%; H1N1 51.1% vs 30.0%) and SP rates (H3N2 48.5% vs 30.9%; B/Bris 60.9% vs 50.7%; H1N1 80.4% vs 73.5%) were seen in patients that received the HD-TIV compared to the SD-QIV. In logistic regression models including age, vaccine type, treatment (G1, G2 and G3); Charlson comorbidity index, and RA duration; vaccine dose and age were the only predictors of the influenza vaccine seroresponse. Patients that received HD-TIV were 2.8 times more likely to H3N2 seroconvert (odds ratio 2.84; 95% confidence interval 1.38 - 5.87), 2 times more likely to B/Bris seroconvert (1.91; 1.15-3.17), and 2.3 times more likely to H1N1 seroconvert (2.33; 1.42-3.85).
Conclusion: In seropositive RA patients, the use of HD-TIV substantially improves the immune response to vaccination compared to SD-QIV. This is the first study documenting a successful intervention to enhance vaccine responses in immunocompromised hosts.
Disclosures: I. Colmegna, None. M. Useche, None. K. Rodriguez, None. M. Hudson, None. S. Bernatsky, None. H. Nedjar, None. E. Rahme, None. B. Ward, None.
RSS