Influenza Vaccine

Which Influenza Vaccine Is More Immunogenic in Rheumatoid Arthritis?

A high-dose trivalent inactivated influenza vaccine (HD-TIV) is not only safe for patients with seropositive rheumatoid arthritis (RA), but also more immunogenic than a standard-dose quadrivalent influenza vaccine (SD-QIV) among this patient population, according to results of a first-of-its-kind randomized, double-blind clinical trial.

To compare the immunogenicity and safety of SD-QIV (15 μg hemagglutinin per strain) with HD-TIV (60 µg hemagglutinin per strain) among adults with RA who are positive for rheumatoid factor and/or anticyclic citrullinated peptide antibodies, the study authors enrolled 279 patients with RA who had visited any of three McGill University–affiliated hospitals between October 24, 2016, and December 6, 2017.

IF YOU LIKE THIS, READ MORE...

Pop Quiz: Rheumatoid Arthritis Treatment Guidelines

SELECT-NEXT Trial: JAK Inhibitor Improves Patient-Reported Outcomes in RA

Based on the RA treatment they had been receiving for 3 months prior to and at enrollment, the participants were stratified into one of three groups:

  1. Those who were taking conventional or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) as monotherapy or in combination.
  2. Those who were taking a biological DMARD, with or without methotrexate, hydroxychloroquine, or sulfasalazine (or a combination thereof).
  3. Those who were taking abatacept, tofacitinib, or rituximab, with or without methotrexate, hydroxychloroquine, or sulfasalazine (or a combination thereof).

 

The researchers randomly assigned participants to receive either SD-QIV (n=140) or HD-TIV (n=139). The seroconversion rate per strain at day 28 was analyzed for 136 participants from the SD-QIV group and for 138 participants from the HD-TIV group.

Participants who received HD-TIV were more likely to seroconvert than those who received SD-QIV. The following seroconversion odds ratios were calculated:

  • 2.99 (95% CI, 1.46-6.11) for seroconversion to strain A/H3N2
  • 1.95 (95% CI, 1.19-3.22) for seroconversion to strain B/Brisbane
  • 3.21 (95% CI, 1.57-6.56) for seroconversion to strain A/H1N1 (during the 2016-2017 influenza season)
  • 2.44 (95% CI, 1.18-5.06) for seroconversion to strain A/H1N1 (during the 2017-2018 influenza season)

 

The participants in RA treatment groups 1 and 2 experienced similar results; RA treatment group 3 did not have a sufficient number of participants for the researchers to draw conclusions.

Local and systemic adverse events (AEs) were similar in both vaccine groups, with no serious AEs reported between days 0 and 28 in any group. Additionally, neither vaccine increased RA disease activity.

“This is the first [randomized controlled trial] comparing standard dose influenza vaccine with HD-TIV in patients with [RA],” the researchers concluded. “It provides evidence of the immunogenicity and safety of the HD-TIV in this population, enhancing our ability to provide informed vaccine recommendations for patients with [RA] and possibly for people living with other chronic inflammatory rheumatic diseases on similar background therapies.”

—Colleen Murphy

Reference:

Colmegna I, Useche ML, Rodriguez K, et al. Immunogenicity and safety of high-dose versus standard-dose inactivated influenza vaccine in rheumatoid arthritis patients: a randomised, double-blind, active-comparator trial. Lancet. 2020;2(1):14-23. doi:10.1016/S2665-9913(19)30094-3.