Rheumatic Disease Patients Require Two Flu Vaccine Doses

Vaccine response independently affected by certain disease-modifying antirheumatic drugs

WEDNESDAY, March 23 (HealthDay News) -- Patients with inflammatory rheumatic diseases require two doses of flu vaccine to achieve the same antibody response as one dose elicits in controls, which may be due in part to the influence of specific disease-modifying antirheumatic drugs (DMARDs), according to a study published online March 7 in Arthritis & Rheumatism.

Cem Gabay, M.D., of the University of Geneva in Switzerland, and colleagues investigated the antibody response of patients with inflammatory rheumatic diseases to adjuvanted split influenza A(H1N1) vaccine, and its determinants. Antibody responses were measured in 173 patients who received two doses of adjuvanted influenza A/09/H1N1 vaccine, and 138 controls who received one dose of the vaccine. Geometric mean titers (GMT) and seroprotection rates were evaluated and a questionnaire elicited factors determining vaccine responses and side effects.

The researchers found that, although both groups had a significant response to the first vaccine dose, patients with rheumatic diseases required two doses of the vaccine to reach similar GMTs and seroprotection rates as those attained with one dose in the controls. The main determinants of lower vaccine responses were increasing age, the use of certain DMARDs, and recent B cell depletion. Immunization was well tolerated and did not have any adverse effect on disease activity.

"A second vaccine dose enabled patients with rheumatic diseases to achieve similar rates of seroprotection and antibody titers as controls. The vaccine responses were not influenced by the nature of the underlying rheumatic disease but rather by age and some types of treatment," the authors write.

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