Systemic Lupus Erythematosus and Nonadjuvant H1N1 Vaccination

Clinicians have reported that influenza vaccination increases autoantibody production and/or disease activity in a significant proportion of patients with systemic lupus erythematosus (SLE).

So during the recent H1N1 epidemic, researchers at the University of Toronto Lupus Clinic and Centre for Prognosis Studies in the Rheumatic Diseases at Toronto Western Hospital in Canada investigated whether the use of adjuvant- and nonadjuvant-containing H1N1 vaccine increased autoantibody production in patients with SLE.

The study, which was published recently in Arthritis Care and Research, included patients with SLE who received H1N1 vaccination and had a battery of nine autoantibodies tested before, and one and three months after, vaccination. The following antibodies were tested for: rheumatoid factor (nephelometry), antinuclear antibody (immunofluorescence), anti-DNA (Farr), anti-RNP, anti-Sm, anti-Ro, anti-La, anti-Scl-70, and anti-Jo-1 (enzyme-linked immunosorbent assay).

Evaluation of patients was conducted using standard protocol, including items necessary to calculate the Systemic Lupus Erythematosus Disease Activity Index 2000 and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index.

In addition, descriptive statistics and McNemar’s test were performed to evaluate change in antibody positivity. To adjust for repeated measures in the comparisons of autoantibodies over visits and vaccine types, multivariate logistic regression was performed.

A total of 103 patients, 94 women and nine men, with a mean ± SD age at vaccination of 43.9 ± 15.2 years and a mean ± SD disease duration of 14.2 ± 11.0 years, were included.

“Fifty-one patients received adjuvant and 52 received nonadjuvant vaccines. Antibody testing was performed a mean of 1.9 months prior to the vaccination. The first postvaccination sample was taken a mean of one month after vaccination and the second a mean of 3.5 months after vaccination,” the authors wrote in the study abstract.

“The percentage of patients with changes in antibodies following vaccination was not statistically significant for most antibodies. After adjusting for the number of tests performed, none of the associations was significant.”

Source

Autoantibody Response to Adjuvant and Nonadjuvant H1N1 Vaccination in Systemic Lupus Erythematosus [Arthritis Care and Research]