Studies reaffirm vaccine safety in patients with rheumatic disease
Three studies presented at the EULAR Annual Congress demonstrated the safety and efficacy of different vaccinations in several patient populations with rheumatic diseases.
In the first study, Yosef Uziel, MD, of Meir Medical Center, Kfar Saba, Israel, and colleagues, investigated the measles-mumps-rubella (MMR) booster vaccine in 234 patients, of whom 206 had juvenile idiopathic arthritis.
“Current recommendations are cautious due to low levels of evidence and so we are launching a prospective study on safety and efficacy of MMR booster vaccine in pediatric rheumatology patients treated with immunosuppressive therapy, including biological therapy,” Uziel said in a press release.
Eligible participants in the retrospective analysis had received a live booster MMR or MMR-varicella (MMRV) vaccine while undergoing treatment with DMARDs, glucocorticoids or biologic agents. The analysis included data from 13 pediatric rheumatology institutions in 10 countries.
Patient data showed 2% of the group had high disease activity, while 7% had moderate and 38% had low.
methotrexate, there were three cases of mild skin reactions and no disease flares reported. For 76 patients who received the booster during treatment with methotrexate plus TNF inhibitors, there were seven mild, local reactions with fever and upper respiratory infections. There was also one fever among 39 patients who were vaccinated while receiving TNF inhibitor monotherapy.
The researchers observed no relationship between disease activity, type, or duration with vaccination outcomes. Vaccines were also not associated with measles, mumps, rubella, or varicella infections.
“The positive results of our study suggest live-attenuated MMR and MMRV booster vaccination is safe in children with rheumatic diseases,” Uziel said.
In a real-world data set, Georgina Nakafero, MD, of the department of academic rheumatology at the University of Nottingham in the U.K., and colleagues, investigated influenza vaccination in 14,928 patients with autoimmune rheumatic disease. Specifically, they were looking for any potential associations between influenza vaccination and disease-related outcomes such as joint pain, fatigue, rheumatoid arthritis flare, corticosteroid prescription and incident vasculitis.
Results showed no associations between the vaccine and any of the outcome measures of interest. Moreover, at 3 months after vaccination, the researchers observed significant reductions in both fatigue (IRR = 0.4; 95% CI, 0.22-0.71) and primary care consultations for joint pain (IRR = 0.9; 95% CI, 0.84-0.96).
“Our results clearly support the use of the flu vaccine in rheumatic patients and should dispel any fears people have about reported links to disease activity or vasculitis,” Nakafero said in a press release.
In a third pivotal study investigating vaccination in patients with rheumatic diseases, Giovanni Adami, MD, of the rheumatology unit at the University of Verona, in Italy, and colleagues aimed to determine the number needed to vaccinate among patients being treated with TNF inhibitors to prevent one influenza infection compared with the general population.
The researchers used data for 71,221 healthy individuals to calculate the number needed to vaccinate to prevent one influenza infection. Results showed that it would be necessary to vaccinate 71 people to reach this result.
By comparison, a similar calculation performed in 15,132 patients with exposure to adalimumab (Humira, AbbVie) showed that it would be necessary to vaccinate just 10 patients with RA on TNF inhibitors to prevent an infection.
The difference is due to the increased risk for influenza in patients with RA, according to the researchers.
“Our analysis provides further evidence on the effectiveness of flu vaccination in patients affected by rheumatoid arthritis receiving treatment with tumor necrosis factor inhibitors and should represent a call-to-action for all rheumatologists to consider vaccination in such patients,” Adami said in a press release. – by Rob Volansky
Uziel Y, et al. OP0205.
Nakafero G, et al. OP0267.
Adami G, et al. OP0230.
All presented at: EULAR Annual Congress; June 12-15, 2019; Madrid.
Disclosures : Adami, Nakafero, Uziel report no relevant financial disclosures.