Immunogenicity of Influenza Vaccine for Patients with Inflammatory Bowel Disease on Maintenance Infliximab Therapy: A Randomized Trial
Immunogenicity of Influenza Vaccine for Patients with Inflammatory Bowel Disease on Maintenance Infliximab Therapy: A Randomized Trial
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DOI：
10.1097/mib.0000000000000615
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发表时间：
2016-03-01
影响因子：
4.9
通讯作者：
Wrobel, Iwona
中科院分区：
文献类型：
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作者：
deBruyn, Jennifer;Fonseca, Kevin;Wrobel, Iwona
背景：对于接受英夫利昔单抗治疗的炎症性肠病 (IBD) 患者，有关流感疫苗免疫反应和疫苗接种时机影响的数据有限。该研究的目的是评估 IBD 患者对英夫利昔单抗流感疫苗的免疫反应以及疫苗接种时机对免疫反应的影响。 方法：在这项随机研究中，137 名接受英夫利昔单抗维持治疗的 IBD 受试者被分配在英夫利昔单抗输注时（n = 69）或输注中间（n = 68）接受 2012/2013 灭活流感疫苗。在接种疫苗之前和之后收集血清用于血凝抑制滴度。血清学保护的定义是疫苗后效价 >= 1:40。 结果：比较英夫利昔单抗接种时接种的受试者与中途接种的受试者，H1N1 疫苗获得血清学保护的比例为 67% 与 66%（P = 0.8），H3N2 疫苗获得血清学保护的比例为 43% 与 49%（P = 0.5），乙型流感疫苗获得血清学保护的比例为 69% 与 79%（P = 0.2）。尽管引起的不良事件很常见（60%），但没有受试者经历需要额外医疗护理的严重不良事件。只有 6% 的受试者的疾病活动评分出现临床显着增加，不受疫苗接种时机的影响。结论：根据抗原的不同，接受英夫利昔单抗维持治疗的 IBD 患者中，只有约 45% 至 80% 的 IBD 患者获得了流感疫苗的血清学保护。然而，重要的是，相对于英夫利昔单抗输注的疫苗接种时机并不影响血清学保护的实现，并且流感疫苗具有良好的耐受性。因此，建议 IBD 患者在英夫利昔单抗计划期间的任何时间接种流感疫苗，并应探索扩大流感疫苗的可用性和便利性以优化覆盖范围的机会。
Background:In patients with inflammatory bowel disease (IBD) on infliximab, data are limited on immune response to influenza vaccine and the impact of vaccine timing. The study aims were to evaluate immune responses to the influenza vaccine in IBD patients on infliximab and the impact of vaccine timing on immune responses.Methods:In this randomized study, 137 subjects with IBD on maintenance infliximab therapy were allocated to receive the 2012/2013 inactivated influenza vaccine at the time of infliximab infusion (n = 69) or midway between infusions (n = 68). Serum was collected before and after vaccination for hemagglutination inhibition titers. Serologic protection was defined by postvaccine titer of >= 1:40.Results:Comparing subjects vaccinated at the time of infliximab with those vaccinated midway, serologic protection was achieved in 67% versus 66% to H1N1 (P = 0.8), in 43% versus 49% to H3N2 (P = 0.5), and in 69% versus 79% to influenza B (P = 0.2). Although solicited adverse events were common (60%), no subject experienced a serious adverse event requiring additional medical attention. Only 6% of subjects had a clinically significant increase in disease activity score, not impacted by vaccine timing.Conclusions:Serologic protection to influenza vaccine is achieved in only approximately 45% to 80% of IBD patients on maintenance infliximab therapy varying by antigen. Yet, importantly, vaccine timing relative to infliximab infusion does not affect the achievement of serologic protection, and the influenza vaccine is well tolerated. Therefore, influenza vaccination at any point during infliximab scheduling is recommended for patients with IBD and opportunities to broaden the availability and convenience of influenza vaccine to optimize coverage should be explored.