Dr. Dedeke has received speaking fees from Pfizer, Abbott, and Forest Laboratories (less than $10,000 each).
Systemic Lupus Erythematosus
Influenza vaccination responses in human systemic lupus erythematosus: Impact of clinical and demographic features
Article first published online: 1 AUG 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 8, pages 2396–2406, August 2011
How to Cite
Crowe, S. R., Merrill, J. T., Vista, E. S., Dedeke, A. B., Thompson, D. M., Stewart, S., Guthridge, J. M., Niewold, T. B., Franek, B. S., Air, G. M., Thompson, L. F. and James, J. A. (2011), Influenza vaccination responses in human systemic lupus erythematosus: Impact of clinical and demographic features. Arthritis & Rheumatism, 63: 2396–2406. doi: 10.1002/art.30388
- Issue published online: 1 AUG 2011
- Article first published online: 1 AUG 2011
- Accepted manuscript online: 19 MAY 2011 10:47AM EST
- Manuscript Accepted: 31 MAR 2011
- Manuscript Received: 12 APR 2010
- NIH (National Institute of Allergy and Infectious Diseases). Grant Numbers: HHSN266200500026C, AR-058554, RR-015577, AI-082714, AR-053483
- Kirkland Foundation Scholar support
Vaccination against common pathogens, such as influenza, is recommended for patients with systemic lupus erythematosus (SLE) to decrease infections and improve health. However, most reports describing the vaccination response are limited to evaluations of SLE patients with quiescent disease. This study focuses on understanding the clinical, serologic, therapeutic, and demographic factors that influence the response to influenza vaccination in SLE patients with a broad range of disease activity.
Blood specimens and information on disease activity were collected from 72 patients with SLE, at baseline and at 2, 6, and 12 weeks after influenza vaccination. Influenza-specific antibody responses were assessed by determining the total serum antibody concentration (Bmax), relative affinity (Ka), and level of hemagglutination inhibition in the plasma. Using a cumulative score, the patients were evenly divided into groups of high or low vaccine responders. Autoantibody levels were evaluated at each time point using immunofluorescence tests and standard enzyme-linked immunosorbent assays.
Compared to high responders, low responders to the vaccine were more likely to have hematologic criteria (P = 0.009), to have more American College of Rheumatology classification criteria for SLE (P = 0.05), and to be receiving concurrent prednisone treatment (P = 0.04). Interestingly, European American patients were more likely to be low responders than were African American patients (P = 0.03). Following vaccination, low responders were more likely to experience disease flares (P = 0.01) and to have increased titers of antinuclear antibodies (P = 0.04). Serum interferon-α activity at baseline was significantly higher in patients in whom a flare occurred after vaccination compared to a matched group of patients who did not experience a disease flare (P = 0.04).
Ancestral background, prednisone treatment, hematologic criteria, and evidence of increased likelihood of disease flares were associated with low antibody responses to influenza vaccination in SLE patients.