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Can We Safely and Effectively Immunize Patients Receiving Anti-TNF Therapies?
Results in rheumatoid arthritis patients demonstrate some benefit from flu and pneumococcal vaccination in patients receiving biologic therapy.
Tumor necrosis factor-
(TNF-) antagonists are approved for treatment of psoriasis, psoriatic arthritis, rheumatoid arthritis (RA), ankylosing spondylitis, and Crohn disease. Because many with these conditions also receive other therapies that suppress the immune response, we generally recommend that such patients receive annual vaccination to prevent influenza. In a study funded by the manufacturer of the TNF- antagonist adalimumab, researchers investigated whether such vaccination is effective.
A total of 226 patients with RA who had discontinued TNF antagonists for at least 2 months received adalimumab (111) or placebo (115) on days 1, 15, and 29 of the study. On day 8, the patients received influenza and pneumococcal vaccines. Their responses were measured by testing for increases in antibody titers following vaccination. Patients in the placebo and treatment groups developed comparable responses to vaccination, with one caveat: More patients in the treatment group than in the placebo group had had protective antibodies for influenza at baseline. In the initial analysis, this suggested that the adalimumab group had a lower post-vaccination response rate, but both groups responded equally well to vaccination when this variable was controlled for.
Comment: This is an important study, as we need to know if patients on biologic therapies obtain effective protection from vaccination. We do not know whether these observations are applicable to patients treated with other TNF antagonists, such as etanercept and infliximab. We also need to determine whether patients with psoriasis or psoriatic arthritis will have the same immunologic response as the RA patients in this study.
— Jeffrey P. Callen, MD
Published in Journal Watch Dermatology March 9, 2007
Citation(s):
Kaine JL et al. Immune responses following administration of influenza and pneumococcal vaccines to patients with rheumatoid arthritis receiving adalimumab. J Rheumatol 2007 Feb; 34:272-9.
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