Can We Safely and Effectively Immunize Patients Receiving Anti-TNF Therapies?

Tumor necrosis factor-α (TNF-α) antagonists are approved for treatment of psoriasis, psoriatic arthritis, rheumatoid arthritis (RA), ankylosing spondylitis, and Crohn disease. Because many with these conditions also receive other therapies that suppress the immune response, we generally recommend that such patients receive annual vaccination to prevent influenza. In a study funded by the manufacturer of the TNF-α antagonist adalimumab, researchers investigated whether such vaccination is effective.

A total of 226 patients with RA who had discontinued TNF antagonists for at least 2 months received adalimumab (111) or placebo (115) on days 1, 15, and 29 of the study. On day 8, the patients received influenza and pneumococcal vaccines. Their responses were measured by testing for increases in antibody titers following vaccination. Patients in the placebo and treatment groups developed comparable responses to vaccination, with one caveat: More patients in the treatment group than in the placebo group had had protective antibodies for influenza at baseline. In the initial analysis, this suggested that the adalimumab group had a lower post-vaccination response rate, but both groups responded equally well to vaccination when this variable was controlled for.