FRI0461 THE ANTI-VACCINE ANTIBODY AGAINST MEASLES, PAROTITIS, RUBELLA, DIPHTHERIA AND HEPATITIS B IN 170 JUVENILE IDIOPATHIC ARTHRITIS PATIENTS
Authors: N. Lybimova, I. Fridman, O. Goleva, R. Raupov, M. Kaneva, S. Kharit, M. Kostik
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with juvenile idiopathic arthritis (JIA) may have lower protective levels of anti-vaccine antibodies due to high inflammatory activity, interrupted or incomplete vaccination schedule, and due to using of immune-modulating drugs, e.g. systemic corticosteroids (CS), methotrexate (MTX) and biologics. Objectives: The aim of our study was to find the predictors of low levels of anti-vaccine antibodies in patients with JIA. Methods: In the present study were included data 170 JIA (55 boys and 115 girls) aged from 2 to 17 years, who received scheduled vaccination before the age of 2 years and before JIA onset against measles, parotitis, hepatitis B, diphtheria and rubella. In all patients the Ig G anti-vaccine antibodies levels were detected with ELISA. In each patient we evaluate the type of the disease (oligoarthritis - 73, polyarthritis - 61, systemic-16 and enthesitis-related arthritis - 20), onset age, presence of uveitis, duration of JIA, treatment with corticosteroids (CS), methotrexate (MTX) and biologics. Data presented with median and 25%-75%. Results: The main demographic characteristics: age of inclusion in the study 11.4 (7.6-14.8) years, disease onset – 6.0 (3.7-9.0) years, disease duration – 3.8 (1.9-6.5) years. Treatment with CS was in 43 (25.3%), MTX in 154 (90,6%) and biologics 82 (48.2%) patients, among them 53 had TNFa-inhibitors. More than 1 biologic consequently received 16/82 (19.5%) patients. Protective levels of anti-measles antibodies was in 98 (57,6%) of all JIA population, anti-parotitis – 136 (80.0%), anti-hepatitis B – 85 (50.0%), anti-diphtheria – 88 (51,7%), anti-rubella – 167 (98.8%). Data of vaccination status and anti-vaccine antibodies levels in the table. In univariate and multivariate regression analysis the main risk factors for anti-measles antibodies levels were MTX using (p=0.045), more than 1 biologics (p=0.0004); for anti-hepatitis B – MTX (p=0.03), for anti-diphtheria antibodies: onset age (p=0.0002), JIA duration (p=0.00007), number vaccine doses (p=0.02), more than 1 biologics (p=0.01); combined treatment with biologics and other drugs (MTX or CS). Parameter No treatment (n=14) MTT, only (n=74) Biologics±MTT ±CS (n=82) P # anti-measels vaccine doses 2.0 (2.0; 2.0) 2.0 (1.0; 2.0) 2.0 (1.0; 2.0) 0.19 Anti-measels IgG, Me/ml 0.28 (0.1; 0.6) 0.4 (0.1-0.7) 0.17 (0.0; 0.29) 0.0002 Protective anti-measels IgG level, n (%) 8 (57) 50 (68) 40 (49) 0.06 # anti-parotitis vaccine doses 2.0 (2.0; 2.0) 2.0 (1.0; 2.0) 2.0 (1.0; 2.0) 0.19 Anti-parotitis IgG, Me/ml 2.0 (1.2; 4.3) 2.8 (1.3; 5.6) 2.5 (1.0; 5.1) 0.47 Protective anti-parotitis IgG level, n (%) 12 (86) 62 (84) 62 (76) 0.38 # anti-diphtheria vaccine doses 5.0 (4.0; 5.0) 4.0 (4.0; 5.0) 5.0 (4.0; 5.0) 0.39 Anti-diphtheria IgG, Me/ml 0.17 (0.0; 1.2) 0.18 (0.0; 0.4) 0.1 (0.0; 0.2) 0.18 Protective anti-diphtheria IgG level, n (%) 9 (64) 42 (57) 37 (45) 0.22 # anti-hepatitis B vaccine doses 3.0 (3.0; 3.0) 3.0 (3.0; 3.0) 3.0 (3.0; 3.0) 0.91 Anti-hepatitis B IgG, Me/ml 0.56 (0.0; 7.5) 11.4 (0.3; 44.8) 10.0 (0.0; 44.1) 0.08 Protective anti-hepatitis B IgG level, n (%) 3 (21) 40 (54) 42 (51) 0.08 # anti-rubella vaccine doses 2.0 (2.0; 2.0) 2.0 (1.0; 2.0) 2.0 (1.0; 2.0) 0.19 Anti-rubella IgG, Me/ml 121.8 (70.0; 200.0) 95.6 (53.3; 198.2) 56.4 (37.0; 100.1) 0.008 Protective anti-rubella IgG level, n (%) 14 (100) 73 (100) 80 (98) 0.34 Conclusion: MTX, biologics and JIA durations are factors influenced on anti-vaccine antibody level. It is necessary to regularly check the levels of anti-vaccine antibodies, especially anti-measels and anti-diphtheria for creation of the individual vaccination plan for JIA patients, treated with MTX and biologics. Disclosure of Interests: None declared