Influenza vaccination tolerated in quiescent SLE

Influenza vaccination does not stimulate disease activity in patients with systemic lupus erythematous, however it is less effective than in healthy controls, according to new findings.Dr Bert Holvast (University of Groningen, the Netherlands) and colleagues identify that SLE patients are known to be at increased risk of morbidity and mortality from influenza. Also, concerns have been raised that influenza vaccination may stimulate disease activity in these patients and may not even be effective given their altered immune status.To investigate, the authors evaluated responses to vaccination with a trivalent influenza vaccine in SLE patients (n=56) and healthy controls (n=18).All patients had quiescent disease (SLE disease activity index 5 or less) and were divided into four groups based on their current drug use: (1) no drug treatment; (2) hydroxychloroquine treatment; (3) azathioprine treatment; (4) prednisone treatment.The authors report that influenza vaccination did not result in changes in disease activity and was "well tolerated". The results indicate that the antibody response against A/H1N1 and A/H3N2 strains of influenza was significantly less robust in SLE patients compared with controls (pAlso, the response against the B/Hong Kong strain was also less robust in the SLE group, but the association was of borderline significance (p=0.051).When considering the effect of immunosuppressive treatment, fewer SLE patients using azathioprine developed fourfold titre rises against A/H3N2 (p=0.041), and fewer achieved titres of 40 against A/H3N2 (p=0.030) compared with the other patient groups."Recent studies have shown that virosomal vaccines generate better cellular immune responses, and they enhance the humoral immune response following vaccination as well. Regarding the hampered humoral and cellular immune response to influenza vaccination in SLE patients, these new vaccines are of particular interest as one might expect them to improve the efficacy of vaccination in SLE patients," Dr Holvast and colleagues add.Reference...