Influenza vaccine administration in rheumatoid arthritis patients under treatment with TNFalpha blockers: safety and immunogenicity

Clin Immunol. 2010 Feb;134(2):113-20. doi: 10.1016/j.clim.2009.09.014. Epub 2009 Oct 21.


Twenty-eight patients with low-moderate, stable rheumatoid arthritis (RA), under treatment with tumor necrosis factor (TNF) alpha blockers, were immunized at least once with non-adjuvanted trivalent influenza vaccine during three consecutive influenza seasons. Antibodies toward A influenza antigens significantly increased and reached protective levels, still detectable 6 months after vaccination, both in RA patients and healthy controls. Response to B antigen instead was only observed from the second year for healthy controls and in the third year for patients. No significant difference in disease activity and anti-nuclear antibodies was observed as a consequence of vaccine administration, whereas T regulatory cells showed a significant increase 30 days after immunization in RA patients. This study confirms safety of influenza vaccine administration in RA patients treated with TNFalpha blockers. The cohort follow-up revealed the overcoming of poor B vaccine antigen immunogenicity via repeated vaccinations. Finally, protective antibody response was still observed 6 months after vaccination.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adalimumab
  • Adult
  • Aged
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Viral / blood*
  • Antibodies, Viral / immunology
  • Antigens, Viral / immunology
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Cell Separation
  • Etanercept
  • Female
  • Flow Cytometry
  • Fluorescent Antibody Technique
  • Humans
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Influenza A virus / immunology
  • Influenza B virus / immunology
  • Influenza Vaccines / blood
  • Influenza Vaccines / immunology*
  • Influenza Vaccines / therapeutic use
  • Influenza, Human / prevention & control*
  • Male
  • Middle Aged
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • T-Lymphocyte Subsets / immunology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Viral
  • Antigens, Viral
  • Antirheumatic Agents
  • Immunoglobulin G
  • Influenza Vaccines
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Etanercept