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09-06-2011 | Article

Flu vaccination response factors in lupus identified

Abstract

Free abstract

MedWire News: US researchers have identified factors that predict the response to flu vaccination in patients with systemic lupus erythematosus (SLE).

Judith James (Oklahoma Medical Research Foundation, Oklahoma City) and colleagues found that ancestral background, prednisone treatment, hematologic criteria, and evidence of increased disease flares were associated with low antibody responses to vaccination.

They say: "Our data indicate that some SLE patients, especially those with a history of hematologic disorder or individuals taking prednisone, mount weak responses to the influenza vaccine."

The team collected blood specimens and disease activity information on 72 SLE patients prior to trivalent influenza vaccination and at 2, 6, and 12 weeks after vaccination. A further 72 healthy controls were also recruited and followed-up.

The overall anti-influenza response was assessed from antibody concentration, relative affinity of serum antibodies, and hemagglutination inhibition and ranked to create a score that was used to evenly divide participants into high and low responders.

SLE patients had reduced humoral responses following vaccination, but the high-responder group generated an anti-influenza response that was much closer in behavior to that of controls than to that of low-responding patients.

African-American patients, who comprised 44% of the group, were significantly more likely to have strong vaccination responses, and were three times as likely as European Americans to be categorized as high responders.

Poor vaccination response was associated with hematologic manifestations and a greater number of American College of Rheumatology (ACR) SLE criteria.

The researchers report that 64% of low responders met six or more ACR criteria for SLE versus 42% of high responders, and more than twice as many low as high responders exhibited at least one hematologic criterion.

Poor humoral immune responses were more common in patients using steroids, with 67% of low responders taking at least the equivalent of prednisone 10 mg/day versus 47% of high responders.

Following vaccination, low responders were also significantly more likely to experience disease flares and to have increased anti-nuclear antibody titers.

Reporting in the journal Arthritis and Rheumatism, the researchers conclude: "Current studies are underway to explore biomarkers which might better predict which patients are likely to flare following vaccination.

"Coupled with select serologic biomarkers in patients who are anticipated to have low responses, this information would help identify the subset of patients who may need to have their underlying disease more aggressively treated before receiving influenza or other vaccination."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Anita Wilkinson