Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Imagem de Miniatura
Citações na Scopus
Tipo de produção
Data de publicação
Título da Revista
ISSN da Revista
Título do Volume
JOURNAL OF RHEUMATOLOGY, v.39, n.1, p.167-173, 2012
Projetos de Pesquisa
Unidades Organizacionais
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. Method's. 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.
  1. Bate J, 2010, CLIN INFECT DIS, V51, pE95, DOI 10.1086/657403
  2. BOHAN A, 1975, NEW ENGL J MED, V292, P344, DOI 10.1056/NEJM197502132920706
  3. Brammer L., 2010, Morbidity and Mortality Weekly Report, V59, P38
  4. Conti F, 2008, AUTOIMMUN REV, V8, P124, DOI 10.1016/j.autrev.2008.07.007
  5. Criteria for diagnosis of Behcet's disease, 1990, LANCET, V335, P1078
  6. Crum-Cianflone NF, 2011, CLIN INFECT DIS, V52, P138, DOI 10.1093/cid/ciq019
  7. De Paepe B, 2007, ANN NY ACAD SCI, V1109, P441, DOI 10.1196/annals.1398.050
  8. Department of Health and Human Services (US) Food and Drug Administration Center for Biologics Evaluation and Research, 2007, GUID IND CLIN DAT NE
  9. Djilali-Saiah I, 2002, J IMMUNOL, V169, P4889
  10. EMEA, 2004, CPMPVEG471703 EMEA
  11. EMEA, 1996, EMEA PUBL
  12. Esposito S, 2011, NEPHROL DIAL TRANSPL, V26, P2018, DOI 10.1093/ndt/gfq657
  13. Faco MMM, 2007, BRAZ J MED BIOL RES, V40, P993, DOI 10.1590/S0100-879X2006005000110
  14. FIORE AE, 2010, MMWR RECOMM REP, V59, P1147
  15. Fiore Anthony E., 2010, Morbidity and Mortality Weekly Report, V59, P1
  16. Fiore Anthony E., 2010, Morbidity and Mortality Weekly Report, V59, P993
  17. Fomin I, 2006, ANN RHEUM DIS, V65, P191, DOI 10.1136/ard.2005.036434
  18. Hanania NA, 2004, J ALLERGY CLIN IMMUN, V113, P717, DOI 10.1016/j.jaci.2003.12.584
  19. Hochberg MC, 1997, ARTHRITIS RHEUM, V40, P1725, DOI 10.1002/art.1780400928
  20. Holvast A, 2009, RHEUMATOLOGY, V48, P1294, DOI 10.1093/rheumatology/kep200
  21. Holvast A, 2009, ANN RHEUM DIS, V68, P873, DOI 10.1136/ard.2008.092924
  22. Holvast A, 2009, ARTHRITIS RHEUM, V60, P2438, DOI 10.1002/art.24679
  23. Iliopoulos AG, 1996, SEMIN ARTHRITIS RHEU, V25, P318, DOI 10.1016/S0049-0172(96)80018-7
  24. Ioannou Y, 1999, LUPUS, V8, P497, DOI 10.1191/096120399678840855
  25. Iorio AM, 1997, VACCINE, V15, P97, DOI 10.1016/S0264-410X(96)00057-6
  26. Isenberg DA, 1998, OXFORD TXB RHEUMATOL, P1157
  27. Kanakoudi-Tsakalidou F, 2001, CLIN EXP RHEUMATOL, V19, P589
  28. Kasapcopur O, 2004, ANN RHEUM DIS, V63, P1128, DOI 10.1136/ard.2003.013201
  29. Kendal AP, 1982, CONCEPTS PROCEDURES
  30. Kunisaki KM, 2009, LANCET INFECT DIS, V9, P493, DOI 10.1016/S1473-3099(09)70175-6
  31. Liang XF, 2010, LANCET, V375, P56, DOI 10.1016/S0140-6736(09)62003-1
  32. MALLESON PN, 1993, J RHEUMATOL, V20, P1769
  33. Ogimi C, 2011, PEDIATR INFECT DIS J, V30, P208, DOI 10.1097/INF.0b013e3181f7ce44
  34. Oh CE, 2010, VACCINE, V28, P5857, DOI 10.1016/j.vaccine.2010.06.060
  35. Ozen S, 2006, ANN RHEUM DIS, V65, P936, DOI 10.1136/ard.2005.046300
  36. Ozen S, 2010, ANN RHEUM DIS, V69, P798, DOI 10.1136/ard.2009.116657
  37. Petty RE, 2004, J RHEUMATOL, V31, P390
  38. Saad CGS, 2011, ANN RHEUM DIS, V70, P1068, DOI 10.1136/ard.2011.150250
  39. Setti M, 2009, VACCINE, V27, P3367, DOI 10.1016/j.vaccine.2009.01.078
  40. Tremblay CL, 2011, VACCINE, V29, P1359, DOI 10.1016/j.vaccine.2010.12.023
  41. Wallin L, 2009, ACTA REUMATOL PORT, V34, P498
  42. [Anonymous], 1980, ARTHRITIS RHEUM, V23, P581