Influenzavaccinatie bij patiënten met lupus erythematodes disseminatus: Veilig, maar minder effectief

Objective. To assess the safety and efficacy of influenza vaccination in patients with systemic lupus erythematosus (SLE), and to evaluate the influence of immunosuppressive medication on the immune response. Design. Prospective, controlled. Method. A total of 56 SLE patients and 18 healthy controls were included. All patients had quiescent disease based on an SLE disease activity index (SLEDAI) ≤ 5. Patients were classified into 4 groups according to immunosuppressive medication use: (a) no medication, (b) hydroxychloroquine, (c) azathioprine and (d) prednisone. All participants received a trivalent influenza subunit vaccine in October or November 2003. Disease activity scores and side effects were recorded. Antibody titres against influenza virus were measured before and 30 days after vaccination using the haemagglutination inhibition assay. Results. Vaccination with an influenza subunit vaccine did not alter disease activity and was well tolerated. Seroconversions to A/H1N1 and A/H3N2 were less frequent in SLE patients than in healthy controls (p < 0.001 for both). A similar trend was seen for the B strain, but the difference did not reach statistical significance (p = 0.051). Compared with other patient groups, SLE patients treated with azathioprine were less likely to develop seroconversion to A/H3N2 (p = 0.041) or achieve litres ≥ 40 against A/H3N2 (p = 0.030). Conclusion. Influenza vaccination in SLE patients with quiescent disease was safe but less effective than in healthy controls. Use of azathioprine was associated with a trend towards a further reduction in vaccination efficacy.