title: The effect of anti-tumour necrosis factor alpha treatment on the antibody response to influenza vaccination.
abstract: OBJECTIVE
  The effect of anti-tumour necrosis factor (TNF) therapy on the antibody responses to vaccines is the subject of ongoing debate. Therefore, we investigated the effect of the three currently available anti-TNF agents on influenza vaccination outcomes in a patient population with long-standing disease.
  
  
  METHODS
  In a prospective cohort study, we assessed the antibody response upon influenza vaccination in 112 patients with long-standing autoimmune disease treated with immunosuppressive medication either with anti-TNF (etanercept, adalimumab or infliximab; n = 64) or without anti-TNF (n = 48) and a control group of 18 healthy individuals. Antibody responses were determined by haemagglutination inhibition assay, before and 4 weeks after vaccination.
  
  
  RESULTS
  The proportion of individuals with a protective titre (>or=40) after vaccination was large (80-94%) and did not significantly differ between the three groups. Post-vaccination geometric mean antibody titres against influenza (A/H3N2 and B) were significantly lower in the 64 patients treated with anti-TNF compared with the 48 patients not receiving anti-TNF, and the healthy controls.
  
  
  CONCLUSIONS
  The antibody response to influenza vaccination in patients treated with anti-TNF is only modestly impaired. The proportion of patients that achieves a protective titre is not significantly diminished by the use of TNF blocking therapies.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands. L.B.S.Gelinck@LUMC.nl
authors.forename: L B S
authors.initials: LB
authors.lastname: Gelinck
authors.forename: A E
authors.initials: AE
authors.lastname: van der Bijl
authors.forename: W E P
authors.initials: WE
authors.lastname: Beyer
authors.forename: L G
authors.initials: LG
authors.lastname: Visser
authors.forename: T W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: R A
authors.initials: RA
authors.lastname: van Hogezand
authors.forename: G F
authors.initials: GF
authors.lastname: Rimmelzwaan
authors.forename: F P
authors.initials: FP
authors.lastname: Kroon
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000914:Antibodies, Viral / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology*; D016022:Case-Control Studies; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology; D000068800:Etanercept; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept