Patients taking anti-tumor necrosis factor-α medications show somewhat impaired antibody response to influenza vaccination, but there is no decrease in the proportion of patients achieving a protective titer.
A study, by Dr. L.B.S. Gelinck of Leiden (the Netherlands) University Medical Center and colleagues, compared immunologic responses to the influenza vaccine in 64 patients taking anti-tumor necrosis factor-α (anti-TNF-α) medications for various autoimmune diseases with 48 patients with autoimmune diseases who were not taking those drugs. There were 18 healthy controls. All three groups achieved about an 80% rate of protection to each of the three components of the influenza vaccine (Ann. Rheum. Dis. 2007;doi:10.1136/ard.2007.077552).
Guidelines issued by the Centers for Disease Control and Prevention recommend annual vaccination for patients at risk of complications of influenza, including those treated with anti-TNF-α agents such as infliximab, etanercept, and adalimumab. On the other hand, findings from earlier studies on the effect of influenza vaccination on these patients were conflicting.
Patients with several autoimmune diseases were represented in the study. Their average age was 49 years, with a range of 18–85. Patients in the anti-TNF group had been using the agents for an average of 24 months with a range of 0.5–78 months.
All of the patients in the study were vaccinated in the fall or winter of 2003 with a commercially available trivalent subunit influenza vaccine. Four weeks after vaccination, patients taking an anti-TNF-α agent had significantly lower geometric mean titers to two out of the three vaccine components, compared with the patients not taking an anti-TNF-α agent and with the healthy controls.