Crohn’s disease patients on biologics show variable response to trivalent influenza vaccination, with those on ustekinumab showing a considerably more favorable immune response compared to those on adalimumab (69.2% vs. 18.2% respectively).
Trivalent influenza vaccination triggered high rates of an immune response in patients with Crohn’s disease treated with ustekinumab, but this response was not seen in patients on adalimumab, shows a study comparing seroresponses in patients on the two biologic agents.
Presenting the results at this year’s United European Gastroenterology (UEG) week conference was Dr. Rogier Goetgebuer, Ph.D. Candidate and resident at Erasmus MC, University Medical Center Rotterdam, Gastroenterology and Hepatology, the Netherlands.
“We found that ustekinumab-treated patients had high seroconversion rates to influenza vaccination that is not worse than healthy controls, while adalimumab-treated patients showed a lower immune response to the same vaccination,” reported Dr. Goetgebuer.
“Patients treated with ustekinumab can be effectively vaccinated with the trivalent influenza vaccine,” he asserted.
There were also high pre-vaccination levels of seroprotection for influenza and we believe this is due to prior vaccinations to other infections,” he added.
The study aimed to investigate the immune response to the 2018-2019 inactivated trivalent influenza vaccine in Crohn's disease patients treated with ustekinumab compared to Crohn's disease patients treated with adalimumab and healthy controls.
A vaccination cohort comprised of three subgroups was enrolled: patients with Crohn's disease who were treated with ustekinumab (15 patients); those treated with adalimumab (14 patients); and healthy participants (20 participants). Those patients treated with adalimumab, as well as the healthy participants, were age and gender-matched as control populations.
In the group on ustekinumab, four patients received co-medication (two methotrexate, one high-dose prednisone, and one low-dose prednisone). In those on adalimumab, five patients received co-medication (two thiopurines, and three low-dose prednisone).
All patients were vaccinated with the 2018-19 trivalent influenza vaccine comprised of H3N2, H1N1, and BVictoria, given between October and December 2018. Blood was taken at the time of inclusion, month one and month three, and a further withdrawal will be performed at month nine, explained Dr. Goetgebuer. Haemagglutination inhibition assays were performed to assess the immune response for all three influenza vaccine strains (A/Michigan/2015/H1N1; A/Singapore/2016/H3N2, B/Victoria) across the different participant groups.
There were many more females in the ustekinumab group (73.3%) versus the adalimumab (35.7%) and the healthy group (55%). Mean age was around 50 years in all groups; patients had used adalimumab longer (mean 45.5 months) than ustekinumab (29.4 months), and immunosuppressive medication was similar across patient groups. “This is important because patients on these medications might find they have an effect on immune response,” Dr. Goetgebuer pointed out. “Likewise, vaccination history was similar across groups.”
The seroprotection rate refers to the percentage of patients that achieve a titer of greater than 1:40. “It is remarkable that at baseline there was already a high seroprotection rate, especially for the H3N2 strain. This was more than expected,” said Dr. Goetgebuer. “Also, again, it was surprising that after one month there were very high seroprotection rates and these remained high after three months.”
The early career researcher also looked at the seroconversion rate which represents the percentage of patients with greater than four times the rise in titer from baseline. “This speaks for the maintenance of protection,” he noted. “We saw that ustekinumab patients had higher seroconversion rates [69.2%] than adalimumab patients [18.2%] and this was significant [p=0.012]. Healthy participants had a 30% seroconversion rate, and adalimumab patients had low seroconversion rates.”
Looking at geometric mean titers, these were low in adalimumab patients, added Dr. Goetgebuer.
An audience member asked whether Dr. Goetgebuer believed his results might be extended to other types of vaccination? The doctor said that he thought this was the case, despite not studying it.
Source:
OP008 - HIGH SEROCONVERSION RATE TO TRIVALENT INFLUENZA VACCINE DURING USTEKINUMAB TREATMENT IN CROHN'S DISEASE: RESULTS FROM A PROSPECTIVE COHORT STUDY. R. Goetgebuer, Netherlands. UEG Week 2019. Presented 21 October 2019.