title: Infliximab and/or immunomodulators inhibit immune responses to trivalent influenza vaccination in adults with inflammatory bowel disease.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Hagihara
authors.affiliation: Department of Public Health, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Ohfuji
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan. Electronic address: kenjiw@med.osaka-cu.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yamagami
authors.affiliation: Department of Public Health, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Wakaba
authors.initials: W
authors.lastname: Fukushima
authors.affiliation: Research Foundation for Microbial Diseases of Osaka University, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kamata
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Mitsue
authors.initials: M
authors.lastname: Sogawa
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Shiba
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanigawa
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Public Health, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hirota
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D000911:Antibodies, Monoclonal / Q000494:pharmacology* / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood*; D001379:Azathioprine / Q000494:pharmacology; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007110:Immunity, Active / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D000069285:Infliximab; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000276:immunology*; D008297:Male; D015122:Mercaptopurine / Q000494:pharmacology; D008727:Methotrexate / Q000494:pharmacology; D008875:Middle Aged; D011446:Prospective Studies; D016559:Tacrolimus / Q000494:pharmacology
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine; D016559:Tacrolimus; D008727:Methotrexate
keywords: Immune responses; Immunomodulator; Inflammatory bowel disease; Infliximab; Influenza vaccine