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

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author BORBA, Eduardo F. FMUSP-HC
SAAD, Carla G. S. FMUSP-HC
PASOTO, Sandra G. FMUSP-HC
CALICH, Ana L. G. FMUSP-HC
AIKAWA, Nadia E. FMUSP-HC
RIBEIRO, Ana C. M. FMUSP-HC
MORAES, Julio C. B. FMUSP-HC
LEON, Elaine P. FMUSP-HC
COSTA, Luciana P. FMUSP-HC
GUEDES, Lissiane K. N. FMUSP-HC
SILVA, Clovis A. A. FMUSP-HC
GONCALVES, Celio R. FMUSP-HC
FULLER, Ricardo FMUSP-HC
OLIVEIRA, Suzimara A. FMUSP-HC
ISHIDA, Maria A.
PRECIOSO, Alexander R.
BONFA, Eloisa FMUSP-HC
dc.date.issued 2012
dc.identifier.citation RHEUMATOLOGY, v.51, n.6, p.1061-1069, 2012
dc.identifier.issn 1462-0324
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/548
dc.description.abstract 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) epsilon 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 epsilon 20 mg (53.9%; P = 0.028), IS (55.7%; P = 0.035) and PRED epsilon 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 epsilon 20 mg + CQ (71.4%; P = 1.00), IS + CQ (65.2%; P = 0.54) and PRED epsilon 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.
dc.description.sponsorship · Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2009/51897-5, 2010/10749-0]
· Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ) [303165/2008-1, 300248/2008-3, 301411/2009-3]
· Federico Foundation
· Butantan Foundation
dc.language.iso eng
dc.publisher OXFORD UNIV PRESS
dc.relation.ispartof Rheumatology
dc.rights restrictedAccess
dc.subject vaccine; infection; influenza; antimalarials; disease-modifying anti-rheumatic drugs; immunosuppressive; H1N1 vaccination; immune response; efficacy; prevention
dc.subject.other systemic-lupus-erythematosus; humoral immune-response; rheumatic-diseases; malaria chemoprophylaxis; antibody-response; in-vivo; safety; chloroquine; immunization; recommendations
dc.title Influenza A/H1N1 vaccination of patients with SLE: can antimalarial drugs restore diminished response under immunosuppressive therapy?
dc.type article
dc.rights.holder Copyright OXFORD UNIV PRESS
dc.description.group LIM/17
dc.description.group LIM/36
dc.identifier.doi 10.1093/rheumatology/ker427
dc.identifier.pmid 22298793
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author BORBA, Eduardo F.:FM:MCM
hcfmusp.author SAAD, Carla G. S.:FM:
hcfmusp.author PASOTO, Sandra G.:HC:ICHC
hcfmusp.author CALICH, Ana L. G.:FM:
hcfmusp.author AIKAWA, Nadia E.:FM:
hcfmusp.author RIBEIRO, Ana C. M.:FM:
hcfmusp.author MORAES, Julio C. B.:FM:
hcfmusp.author LEON, Elaine P.:HC:LIM/17
hcfmusp.author COSTA, Luciana P.:FM:
hcfmusp.author GUEDES, Lissiane K. N.:HC:ICHC
hcfmusp.author SILVA, Clovis A. A.:HC:ICR
hcfmusp.author GONCALVES, Celio R.:HC:ICHC
hcfmusp.author FULLER, Ricardo:HC:ICHC
hcfmusp.author OLIVEIRA, Suzimara A.:HC:ICHC
hcfmusp.author BONFA, Eloisa:FM:MCM
hcfmusp.author.external · ISHIDA, Maria A.:Univ Sao Paulo, Fac Med, Adolfo Lutz Inst, BR-05403010 Sao Paulo, Brazil
· PRECIOSO, Alexander R.:Butantan Inst, Sao Paulo, Brazil
hcfmusp.origem.id WOS:000304200100018
hcfmusp.origem.id 2-s2.0-84861466575
hcfmusp.publisher.city OXFORD
hcfmusp.publisher.country ENGLAND
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dc.description.index MEDLINE
hcfmusp.citation.scopus 28
hcfmusp.citation.wos 24
hcfmusp.affiliation.country Brasil


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