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NEW YORK (Reuters Health) Jul 06 - Influenza vaccination does not induce disease activity in patients with systemic lupus erythematous (SLE), but it is less effective than in healthy individuals, according to a report in the Annals of the Rheumatic Diseases for July. The results also suggest that azathioprine use may reduce the efficacy of vaccination.
SLE patients are known to be at increased risk of morbidity and mortality from influenza and therefore vaccination may be of benefit for this group. However, concerns have been raised that influenza vaccination may stimulate disease activity in this patients and may not even be effective given their altered immune status.
To investigate, Dr. Bert Holvast, from the University of Groningen in the Netherlands, and colleagues assessed the outcomes of 56 SLE patients and 18 healthy controls who received Influvac, a trivalent influenza vaccine.
The patients were divided into four groups based on their immunosuppressant use: no treatment, hydroxychloroquine, azathioprine, or prednisone. All of the patients had quiescent disease, with an SLE disease activity index of 5 or less.
As noted, there was no evidence of disease activation in the SLE group 30 days after vaccination, the report indicates. Moreover, the vaccine was well tolerated.
The antibody response against A/H1N1 and A/H3N2 strains of influenza was significantly less robust in SLE patients compared with controls (p< 0.001). The response against the B/Hong Kong strain was also less robust in the SLE group, but the association was of borderline significance.
Azathioprine use appeared to impair the antibody response against A/H3N2, the report shows.
"Recent studies have shown that virosomal vaccines generate better cellular immune responses, and they enhance the humoral immune response following vaccination as well. Regarding the hampered humoral and cellular immune response to influenza vaccination in SLE patients, these new vaccines are of particular interest as one might expect them to improve the efficacy of vaccination in SLE patients," the authors state.
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