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Journal of Crohn's and Colitis: 9 (8)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Published on behalf of

Infliximab and/or immunomodulators inhibit immune responses to trivalent influenza vaccination in adults with inflammatory bowel disease

Yoshie Hagihara, Satoko Ohfuji, Kenji Watanabe, Hirokazu Yamagami, Wakaba Fukushima, Kazuhiro Maeda, Noriko Kamata, Mitsue Sogawa, Masatsugu Shiba, Tetsuya Tanigawa, Kazunari Tominaga, Toshio Watanabe, Yasuhiro Fujiwara, Yoshio Hirota, Tetsuo Arakawa
DOI: http://dx.doi.org/10.1016/j.crohns.2013.08.008 223-233 First published online: 1 March 2014

Abstract

Background and aims Appropriate influenza vaccination is important for patients with inflammatory bowel disease under immunosuppressive therapy. The purpose of this study was to evaluate the influence of immunosuppressive therapy on the immune response to the trivalent influenza vaccine in adult patients with inflammatory bowel disease.

Methods In this cohort study, 91 participants received a single dose of influenza vaccine for the 2010/2011 season. Serum samples were collected at 3 different times (pre-vaccination, 3 weeks post-vaccination, and after flu season) to measure hemagglutination inhibition antibody titers. Immune responses were compared based on immunosuppressive therapy.

Results Among the 88 subjects who completed the study, the influenza vaccine induced a more than 4-fold increase in the mean antibody level for all flu strains. The overall seroprotection proportion (post-vaccination titer ≥ 1:40) was 81% for H1N1, 61% for H3N2, and 86% for B. Treatment with an immunomodulator reduced the immune response to the H1N1 strain (OR = 0.20, p = 0.01), and treatment with infliximab reduced the immune response to the other strains (H3N2 strain: OR = 0.37, p = 0.02; B strain: OR = 0.18, p = 0.03). Combination therapy with azathioprine/6-mercaptopurine and infliximab significantly inhibited the immune response to H1N1 (OR = 0.056, p = 0.02).

Conclusions Infliximab and/or immunomodulators inhibit immune responses to some strains of trivalent influenza vaccination in adults with inflammatory bowel disease. For optimization of the trivalent influenza vaccination for patients with adult inflammatory bowel disease treated with immunosuppressive agents, establishing an effective vaccination method is crucial.

Keywords
  • Inflammatory bowel disease
  • Immunomodulator
  • Infliximab
  • Immune responses
  • Influenza vaccine
  • Abbreviations
    AZA
    azathioprine
    CAI
    clinical activity index
    CD
    Crohn's disease
    CDAI
    Crohn's disease activity index
    CI
    confidence interval
    GMT
    geometric mean titer
    HAI
    hemagglutination inhibition
    IFX
    infliximab
    IS
    group immunosuppressive group
    6MP
    6-mercaptopurine
    NIS
    group non-immunosuppressive group
    OR
    odds ratio
    SD
    standard deviation
    UC
    ulcerative colitis
    WHO
    World Health Organization
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