Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Antimalarials: A Window of Opportunity to Improve the Influenza A/H1N1 Vaccine Response in Lupus Patients Under Immunosuppressive Agents.

Borba1,  Eduardo F., Saad1,  Carla G.S., Pasoto1,  Sandra G., Calich1,  Ana L. G., Aikawa1,  Nadia E., Ribeiro2,  Ana C. M., Moraes2,  Julio C. B.

University of Sao Paulo, Sao Paulo, Brazil
Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
University of Sao Paulo, São Paulo, Brazil
Adolfo Lutz Institute, Sao Paulo, Brazil
Butantan Institute, Sao Paulo, Brazil
Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil

Background/Purpose:

The recent WHO recommendation that the 2010–2011 trivalent seasonal influenza vaccine must contain the A/California/7/2009/H1N1–like virus reinforces the need for an extensive evaluation of its immunogenicity and safety in systemic lupus erythematosus (SLE) patients, particularly those under immunosuppressive therapy.

Methods:

A total of 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a nonadjuvanted preparation. Clinical/laboratory data, treatment and adverse events were monitored prevaccination and 21 days postvaccination. Anti-H1N1 titres, the percentages of seroprotection (SP), and seroconversion (SC) were evaluated.

Results:

After immunisation, lower SP (64.7%; 95%CI 60.7–68.7 vs. 84.1%; 95%CI 78.6–89.6; p<0.0001) and SC rates (60.7%; 95%CI 56.7–64.8 vs. 80.0%; 95%CI 74.0–86.0; p<0.0001) were observed in SLE compared to controls, whereas an equivalent response was detected for the SLE no therapy group (SP, 74.7%; 95%CI 64.8–84.5; p=0.10; and SC, 72.0%; 95%CI 61.8–82.1; p=0.18). A treatment analysis comparing the SLE no therapy group revealed analogous SP (vs. 78.0%; 95%CI 70.1–85.9, p=0.60) and SC (vs. 69.5%; 95%CI 60.7–78.3, p=0.75) for antimalarial monotherapy. Regarding those without antimalarials, a reduced response for prednisone (SC, p=0.04), prednisone daily dose >20 mg (SC, p=0.028), immunosuppressors (SP, p=0.037; and SC, p=0.035) and for the concomitant use of prednisone >20 mg + immunosuppressors (SC, p=0.038) was observed. In contrast, the association of antimalarials with prednisone >20 mg (SC, p=1.00), with immunosuppressors (SC, p=0.54) and with prednisone >20 mg + immunosuppressors (SC, p=0.09) resulted in a comparable immunoresponse for the SLE therapy group.

Conclusion:

Antimalarials may be a promising, inexpensive candidate to improve pandemic influenza A H1N1/2009 response in lupus patients under immunosuppressive therapy. This finding predicts a window of opportunity for other autoimmune conditions (ClinicalTrials.gov, number NCT01151644).

To cite this abstract, please use the following information:
Borba, Eduardo F., Saad, Carla G.S., Pasoto, Sandra G., Calich, Ana L. G., Aikawa, Nadia E., Ribeiro, Ana C. M., et al; Antimalarials: A Window of Opportunity to Improve the Influenza A/H1N1 Vaccine Response in Lupus Patients Under Immunosuppressive Agents. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :581
DOI:

Abstract Supplement

Meeting Menu

2011 ACR/ARHP