Antibody responses to influenza vaccine in patients on biological therapy: Results of RIER cohort study.

BACKGROUND AND OBJECTIVES: Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. MATERIAL AND METHODS: Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014-2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. RESULTS: 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p<0.001). Anti-TNF drugs were associated with better response and rituximab with the worst (79.2% vs 55.0% for final seropositivity against antigen A, p=0.020). Vaccine response in the rituximab group tended to improve when the interval between the drug administration and the vaccination was at least 12 weeks (seropositivity rate 80.0% in those with the longer interval vs 25.0% in the other group, p=0.054). CONCLUSIONS: Among the patients on biological therapy vaccinated against influenza, anti-TNF therapy was identified as a predictive factor of final seropositivity. Rituximab presented a lower rate of final seropositivity, which could be increased with an accurate administration schedule.

Tratamiento de fondo del síndrome seco. ¿Qué puede aportar el reumatólogo? / Etiologic treatment of sicca syndrome. What can the rheumatologist offer?

En el síndrome de Sjögren primario (SSP) no se ha descrito hasta el momento una terapia eficaz para las manifestaciones glandulares a pesar del desarrollo de múltiples agentes orales y biológicos en los últimos años. Varios fármacos empleados como tratamiento de fondo en otras enfermedades se han probado empíricamente y, reconocida la hiperactividad de la célula B en el SSP, también los moduladores de estas se han ensayado en esta enfermedad. En este artículo se revisan los datos existentes sobre el uso de tratamientos modificadores de la enfermedad exclusivamente en el síndrome seco, encontrando que los ensayos publicados con fármacos antirreumáticos orales han mostrado resultados contradictorios y desalentadores, mientras que algunos tratamientos biológicos han resultado esperanzadores. Los problemas encontrados se centran sobre todo en la falta de una correcta y homogénea metodología en los diseños de los ensayos (AU)

No effective treatment has been documented for the glandular primary Sjögren syndrome (PSS) despite the development of oral and biologic agents that have significant activity against other autoimmune disorders. Some disease-modifying agents have been empirically evaluated for the treatment of PSS. Targeting B cells also seems very promising in SSP because of the B-cell hyperactivity recognized in this desease. This article reviews existing data on the use of disease-modifying therapy for glandular of SSP. To date, published studies and trials of oral DMARDs for the treatment of SSP have shown disappointing results. B-cell modulation is clearly a promising therapy for PSS. Many challenges in trial design and execution are evident from the studies reviewed (AU)