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Reduced antibody formation after influenza vaccination in patients with neuromyelitis optica spectrum disorder treated with rituximab

Authors
Kim, W.Kim, S. -H.Huh, S. -Y.Kong, S. -Y.Choi, Y. J.Cheong, H. J.Kim, H. J.
Issue Date
6월-2013
Publisher
WILEY-BLACKWELL
Keywords
influenza; multiple sclerosis; neuromyelitis optica; neuromyelitis optica spectrum disorder; rituximab; vaccination
Citation
EUROPEAN JOURNAL OF NEUROLOGY, v.20, no.6, pp.975 - 980
Indexed
SCIE
SCOPUS
Journal Title
EUROPEAN JOURNAL OF NEUROLOGY
Volume
20
Number
6
Start Page
975
End Page
980
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/103115
DOI
10.1111/ene.12132
ISSN
1351-5101
Abstract
Background and purpose Vaccination against infection becomes important in patients with neuromyelitis optica spectrum disorder (NMOSD) because they are at an increased risk of infection due to long-term immunosuppressive therapy. However, it is unclear whether NMOSD patients under immunosuppression therapy show proper antibody formation after vaccination. Thus the antibody formation after influenza A (H1N1) vaccination in patients with NMOSD receiving rituximab was evaluated. Methods The study enrolled 26 patients with NMOSD, nine with multiple sclerosis and eight healthy controls. The enrolled patients had been treated with rituximab (n=16), mycophenolate mofetil (n=5), azathioprine (n=6) and interferon- (IFN-) (n=8). Antibodies against the H1N1 influenza virus were measured in the serum drawn just before (T0) and between 3 and 5weeks after (T1) vaccination. The immunization states for hepatitis B virus surface antigen, measles and tetanus during the treatment period were also tested. Results The rituximab group showed significantly lower geometric mean titer, seroprotection rate and mean fold increase than the azathioprine group, IFN- group and healthy controls, and a lower seroconversion rate than the IFN- group. This decrease in vaccination efficacy was also shown in patients receiving mycophenolate mofetil. The immunization state for hepatitis B virus surface antigen, measles and tetanus remained the same during the treatment period with each drug, suggesting that these treatments do not affect previously formed immunity. Conclusion This study shows a severely hampered humoral immune response to H1N1 influenza vaccine in patients with NMOSD treated with rituximab, although the vaccination itself is safe in these patients.
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