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Influenza Vaccine Ineffective for RA Patients During First 6 Months of Rituximab Treatment HOBOKEN, NJ -- January 6, 2010 -- Patients with rheumatoid arthritis (RA) are partially protected by the influenza vaccine 6 to 10 months after treatment with rituximab, according to a study published in the January 2010 issue of the journal Arthritis & Rheumatism. Researchers determined that while the influenza vaccine is safe, it is ineffective for patients with RA in the first 6 months following rituximab treatment. Previous influenza vaccination in rituximab-treated patients does increase pre- and post-vaccination titers, providing some defense to influenza strains. RA activity was not influenced by administration of the influenza vaccine. Sander van Assen, MD, University Medical Center Groningen, Groningen, the Netherlands, and colleagues conducted the largest study to date of the effectiveness of the influenza vaccine in patients with RA using rituximab. The study enrolled 23 patients using rituximab, 20 patients taking methotrexate (MTX), and 29 healthy individuals. Patients taking rituximab were split into 2 groups with 11 who received the influenza vaccine 4 to 8 weeks after treatment with rituximab (early rituximab subgroup), and 12 individuals who were given the influenza vaccine 6 to 10 months post-treatment with the drug (late rituximab subgroup). Influenza vaccines were administered intramuscularly between October 2007 and January 2008. Researchers tested geometric mean titers (GMTs) for each group and found they significantly increased for all influenza strains in the MTX-treated group and in healthy controls, but for none of the influenza strains in the rituximab-treated group. In the late rituximab subgroup, a rise in GMT was noted for the A/H3N2 and seasonal A/H1N1 strains indicating some recovery of an immune response 6 to 10 months after treatment by rituximab. Also less rituximab-treated patients reached levels of antibodies needed for protection against influenza for the A/H3N2 and seasonal A/H1N1 when compared with MTX-treated patients, and for the seasonal A/H1N1 when compared with healthy individuals. Results further showed that healthy individuals vaccinated the year before showed higher baseline GMT for the A/H3N2 strain than unvaccinated health controls. In the MTX group, higher baseline antibodies were noted for the seasonal A/H1N1 and B strains in previously vaccinated patients compared with unvaccinated subjects. For the Rituximab group, patients previously vaccinated not only had a higher baseline GMT, but also a higher post-vaccination GMT for the seasonal A/H1N1 than patients who were not vaccinated the prior year. The researchers determined that RA activity was not influenced by the influenza vaccine and used the disease activity (DAS28) score prior to vaccination and at 7 and 28 post-vaccination to assess RA activity in patients in the MTX and rituximab groups. “Individuals who have compromised immune systems, such as with RA, are at risk for complications from contracting influenza,” said Dr. van Assen. “We recommend yearly influenza vaccination for all RA patients and preemptive vaccination for influenza should be considered by those patients who start rituximab treatment.” SOURCE: Wiley-Blackwell E-mail this page to a friend or colleague! To print, use this version