%0 Journal Article
%T Vaccination response to protein and carbohydrate antigens in patients with rheumatoid arthritis after rituximab treatment
%A Maria Rehnberg
%A Mikael Brisslert
%A Sylvie Amu
%A Kiandoht Zendjanchi
%A Gunilla H£¿wi
%A Maria I Bokarewa
%J Arthritis Research & Therapy
%D 2010
%I BioMed Central
%R 10.1186/ar3047
%X Influenza (Afluria) and pneumococcal polysaccharides (Pneumo23) vaccines were given 6 months after rituximab (post-RTX group, n = 11) or 6 days before rituximab treatment (pre-RTX group; n = 8). RA patients never exposed to RTX composed the control group (n = 10). Vaccine-specific cellular responses were evaluated on day 6 after vaccination, and vaccine-specific humoral responses, on day 21.On day 6 after vaccination, formation of influenza-specific B cells was lower in post-RTX group as compared with the pre-RTX group and controls (P = 0.04). Polysaccharide-specific B cells were found in 27% to 50%, being equally distributed between the groups. On day 21, the impairment of humoral responses was more pronounced with respect to influenza as compared with the pneumococcal vaccine and affected both IgG and light-chain production. Total absence of influenza-specific IgG production was observed in 55% of the post-RTX group.RTX compromises cellular and humoral vaccine responses in RA patients. However, repeated RTX treatment or previous anti-tumor necrosis factor (anti-TNF) treatment did not accentuate these defects.Infections are one of the important causes of death in rheumatoid arthritis (RA) [1-3]. For that reason, RA patients are advised to be vaccinated against influenza and pneumococci [4,5]. Antirheumatic treatment including conventional disease-modifying drugs and TNF inhibitors [6-8] may negatively affect the immunization response. Inhibitor of folate metabolism, methotrexate (MTX), impairs optimal immunization response, whereas the effect of corticosteroids and azathioprine was less pronounced [9,10]. The combination of MTX and TNF inhibitors induces further deterioration of the immunization response [8]. The use of rituximab (RTX), a monoclonal antibody targeting CD20-expressing B cells, is an efficient novel strategy of RA treatment [11]. Preliminary data suggest that RTX treatment may impair the response to the influenza vaccine [11].In this study, we evalua
%U http://arthritis-research.com/content/12/3/R111