Effectiveness of inactivated influenza vaccine in autoimmune rheumatic diseases treated with disease-modifying anti-rheumatic drugs

Mallen, Christian D; Nakafero, Georgina; Grainge, Matthew J; Myles, Puja R.; Zhang, Weiya; Doherty, Michael; Nguyen-Van-Tam, Jonathan S; Abhishek, Abhishek

Abstract

Objectives
The effectiveness of inactivated influenza vaccine in people with autoimmune rheumatic disease (AIRDs) is not known. We investigated whether the influenza vaccine is effective in preventing respiratory morbidity, mortality and all-cause mortality in AIRD patients.

Methods
Adults with AIRDs treated with DMARDs prior to 1 September of each year between 2006 and 2009, and 2010 and 2015 were identified from the Clinical Practice Research Datalink. Exposure and outcome data were extracted. Data from multiple seasons were pooled. Propensity score (PS) for vaccination was calculated. Cox-proportional hazard ratios (HRs) and 95% CIs were calculated, and were (i) adjusted, (ii) matched for PS for vaccination.

Results
Data for 30 788 AIRD patients (65.7% female, 75.5% with RA, 61.1% prescribed MTX) contributing 125 034 influenza cycles were included. Vaccination reduced risk of influenza-like illness [adjusted HR (aHR) 0.70], hospitalization for pneumonia (aHR 0.61) and chronic obstructive pulmonary disease exacerbations (aHR 0.67), and death due to pneumonia (aHR 0.56) on PS-adjusted analysis in the influenza active periods (IAPs). The associations were of similar magnitude and remained statistically significant on PS-matched analysis except for protection from influenza-like illness, which became non-significant. Sub-analysis restricted to pre-IAP, IAP and post-IAP did not yield evidence of residual confounding on influenza-like illness and death due to pneumonia. Vaccination reduced risk of all-cause mortality, although IAP-restricted analysis demonstrated residual confounding for this outcome.

Conclusion
Influenza vaccine associates with reduced risk of respiratory morbidity and mortality in people with AIRDs. These findings call for active promotion of seasonal influenza vaccination in immunosuppressed people with AIRDs by healthcare professionals.

Citation

Mallen, C. D., Nakafero, G., Grainge, M. J., Myles, P. R., Zhang, W., Doherty, M., Nguyen-Van-Tam, J. S., & Abhishek, A. (2020). Effectiveness of inactivated influenza vaccine in autoimmune rheumatic diseases treated with disease-modifying anti-rheumatic drugs. Rheumatology, 59(12), 3666–3675. https://doi.org/10.1093/rheumatology/keaa078

• Journal Article Type: Article
• Acceptance Date: Jan 28, 2020
• Online Publication Date: Mar 11, 2020
• Publication Date: Dec 1, 2020
• Deposit Date: Feb 4, 2020
• Publicly Available Date: Mar 11, 2020
• Journal: Rheumatology
• Electronic ISSN: 1462-0324
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Issue: 12
• Pages: 3666–3675
• DOI: https://doi.org/10.1093/rheumatology/keaa078
• Keywords: Pharmacology (medical); Rheumatology
• Public URL: https://nottingham-repository.worktribe.com/output/3884675
• Publisher URL: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaa078/5803181