Talk: Impact of Clinical and Demographic Features On Influenza Vaccination Responses in Human Systemic Lupus Erythematosus (2009 ACR/ARHP Annual Scientific Meeting)

Sunday, October 18, 2009: 3:45 PM

103 A (Pennsylvania Convention Center)

Sherry R. Crowe¹, Jourdan R. Anderson¹, Amy B. Dedeke², Virginia C. Roberts¹, Gillian M. Air², Linda F. Thompson¹ and Judith A. James¹, ¹Oklahoma Medical Research Foundation, Oklahoma City, OK, ²Oklahoma University Health Sciences Center, Oklahoma City, OK

Presentation Number: 566

Purpose: Infectious diseases are a serious cause of morbidity and mortality in immunocompromised individuals, such as those with systemic lupus erythematosus (SLE). Vaccination against common infections, such as influenza, is recommended for SLE patients to decrease infections and improve health. However, few reports detail how SLE patients respond to this common vaccination. The goal of this study is to understand the clinical, serological, therapeutic, and demographic factors which influence the immune response to influenza vaccination in SLE patients.

Method: Over three influenza seasons (October 2005 to February 2008), 72 SLE patients and matched controls were enrolled. Each individual provided detailed clinical (medication usage, previous vaccinations, etc) and demographic (age, race, etc) information. Blood was collected from each individual on the day of influenza vaccination, as well as two, six, and twelve weeks post vaccination. Influenza-specific antibody responses were evaluated by standard ELISAs, relative antibody affinities, and hemagglutination inhibition levels. Based upon these data, individuals were grouped into high and low responders. Autoantibody levels were evaluated at each time-point by immunoflourescence and standard ELISAs.

Results: Poor responders to influenza vaccination were more likely to have hematologic criteria (p = 0.009), exhibit more ACR criteria (p = 0.05), and be receiving prednisone treatment (p = 0.037). No significant differences in the initial autoantibodies between the high and low responders were found, although low responders were more likely to have serum anti-cardiolipin antibodies. Interestingly, the high influenza responder group was enriched for African Americans (p = 0.03) and in fact low responders were 3 times more likely to be Caucasian than African American. All measures of disease activity significantly increased following vaccination: SLEDAI (p = 0.012), PGA (p = 0.007), and SLAM (p = 0.001), but disease activity changes were not enriched in either the high or low responders. Finally, low responders were more likely to increase ANA titers following vaccination (p = 0.045).

Conclusion: In summary, influenza vaccination impacts a significant fraction of SLE patients by increasing autoantibody production and/or disease activity. Poor responders have more ACR criteria, use prednisone and have hematological criteria, suggesting that studies of split doses or withholding prednisone on day of vaccination in some patients may be warranted.

Keywords: antibodies, systemic lupus erythematosus (SLE) and vaccines

Disclosure: S. R. Crowe, None; J. R. Anderson, None; A. B. Dedeke, None; V. C. Roberts, None; G. M. Air, None; L. F. Thompson, None; J. A. James, None.

566 - Impact of Clinical and Demographic Features On Influenza Vaccination Responses in Human Systemic Lupus Erythematosus