Immune response to influenza A/H1N1 vaccine in inflammatory bowel disease patients treated with anti TNF-α agents: effects of combined therapy with immunosuppressants.
Immune response to influenza A/H1N1 vaccine in inflammatory bowel disease patients treated with anti TNF-α agents: effects of combined therapy with immunosuppressants.
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DOI：
10.1016/j.crohns.2012.05.011
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发表时间：
2013-05
影响因子：
8
通讯作者：
Guidi, L.
中科院分区：
文献类型：
--
作者：
Andrisani, G.;Frasca, D.;Romero, M.;Armuzzi, A.;Felice, C.;Marzo, M.;Pugliese, D.;Papa, A.;Mocci, G.;De Vitis, I.;Rapaccini, G. L.;Blomberg, B. B.;Guidi, L.
我们的第一个目标是评估单独使用抗肿瘤坏死因子-α或与免疫抑制剂(IS)联合治疗的炎症性肠病患者对佐剂2009A/H1N1大流行疫苗的免疫应答。第二个和第三个目标是PH1N1疫苗的安全性和对IBD临床活动的影响。36例克罗恩病(CD)患者，26例溃疡性结肠炎(UC)患者和31例健康对照(HC)。47例患者接受抗肿瘤坏死因子α维持治疗，15例患者接受抗肿瘤坏死因子α联合IS治疗。在接种前(T0)和接种后4周(T1)收集血清，通过血凝抑制法检测抗体(HAI疾病活动性在T0和T1监测)。患者的血清保护性滴度(≥1：40)与HC相当。在IBD患者中，无论是抗≥-α单药治疗(p=0.034)还是与IS联合治疗(p=0.011)，其血清转换率(HAI滴度增加4倍)均低于HC(p=0.09)。联合治疗患者T1时的抗体几何平均滴度(GMT)显著低于单一治疗患者(p=0.0017)和HC患者(p=0.011)。IBD患者在T1时的GMT较T0时的因子增加显著低于HC(p=0.042)，在联合免疫抑制组中，两者均低于单一治疗(p=0.0048)和HC(p=0.0015)。所有患者均未出现疾病发作。我们的研究显示，在接受抗肿瘤坏死因子-α治疗的IBD患者中，对PH1N1疫苗的反应不佳，并与抗肿瘤坏死因子-α单一治疗和HC治疗进行了比较。
Our first objective was to evaluate the immune response to the adjuvanted 2009 A/H1N1 pandemic (pH1N1) vaccine in inflammatory bowel disease (IBD) patients treated with anti-TNF-α alone or combined with immunosuppressants (IS). Second and third aims were the safety of pH1N1 vaccine and the effects on IBD clinical activity. 36 patients with Crohn's disease (CD) and 26 with ulcerative colitis (UC) and thirty-one healthy control subjects (HC) were enrolled. 47 patients were on anti TNF-α maintenance monotherapy and 15 on anti TNF-α combined with IS. Sera were collected at baseline (T0) and 4 weeks after the vaccination (T1) for antibody determination by hemagglutination inhibition (HAI Disease activity was monitored at T0 and T1. Seroprotective titers (≥ 1: 40) in patients were comparable to HC. Seroconvertion rate (≥ 4 fold increase in HAI titer) was lower than HC in IBD patients (p=0,009), either on anti TNF-α monotherapy (p=0,034) or combined with IS (p=0,011). Geometric mean titer (GMT) of antibodies at T1 was significantly lower in patients on combined therapy versus those on monotherapy (p=0,0017) and versus HC (p=0,011). The factor increase of GMT at T1 versus T0 was significantly lower in IBD patients versus HC (p=0,042), and in those on combined immunosuppression, both versus monotherapy (p=0,0048) and HC (p=0,0015). None of the patients experienced a disease flare. Our study has shown a suboptimal response to pH1N1 vaccine in IBD patients on therapy with anti TNF-α and IS compared to those on anti-TNF-α monotherapy and HC.
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