POS1293 RISK FACTORS OF NON-PROTECTIVE LEVELS OF ANTIBODIES TO VACCINES IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS
Authors: N. Lybimova, I. Fridman, O. Goleva, S. Kharit, M. Kostik
Journal: Annals of the Rheumatic Diseases (2021)

Background: Immunosuppressive drugs, decreased vaccine coverage, aberrant immunity might be factors of low anti-vaccine antibodies in JIA patients. Objectives: The study aimed to evaluate risk factors of non-protective levels of antibodies against measles, mumps, rubella, hepatitis B and diphtheria in JIA patients. Methods: A prospective study included 170 children diagnosed with JIA aged 2 to 17 years, who received routine vaccinations against measles, rubella, mumps, diphtheria and hepatitis B. In all patients, the levels of post-vaccination antibodies (IgG) for measles, rubella, mumps, hepatitis B and diphtheria measured with ELISA. Results: Protective level of antibodies were 50% against hepatitis B, 52% diphtheria, 58% measles, 80% mumps, 98%rubella. The best coverage for MMR had patients with enthesytis-related arthritis85%, compare to oligoarthritis70%, polyarthritis69%, systemic arthritis63%. Diphtheria coverage was 50%, 51%, 46%, 63%, respectively. Incomplete MMR vaccination had 39%patients, treated with biologics, 22%with methotrexate and 14%with NSAID(p=0.025), and 61%, 46%, 36% for diphtheria (p=0.021). Incomplete vaccination was a risk factor of non-protective level of antibodies against measles (HR=2.03[95%CI: 1.02; 4.0], p=0.042), parotitis (HR=6.25[95%CI: 2.13; 17.9], p=0.0008) and diphtheria (HR=2.39[95%CI:1.18; 4.85], p=0.016) vaccines. The lowest probability of having a protective level of antibodies was observed in systemic arthritis compared to oligoarthritis (p=0.008) and polyarthritis (p=0.005). JIA patients, with non-protective levels of antibodies against measles, had more extended methotrexate treatment (2.8 [1.3; 6.4] vs 2.2 [0.9; 3.9] years, p&lt;0.05) and increased applying of the biologics (76% vs 52%, p&lt;0.05). Patients treated with biologics had the lowest probability of having protective levels of antibodies against measles, mumps, hepatitis B, and diphtheria than MTX and NSAID. Patients with non-protective antibodies had lower vaccine coverage against mumps (56% vs 67%, p&lt;0.05) and diphtheria (38% vs 61%, p&lt;0.01), longer duration of methotrexate 3.3 [1.4; 6.7] vs 1.8 [1.0; 2.9] years, p&lt;0.01) and biologic treatment 3.1 [1.1; 5.4] vs 0.9 [0.0; 1.9] years, p&lt;0.05) compare to patients with protective levels. The main risk factors to have non-protective levels of antibodies against specific vaccines are in Table 1 below. Table 1. Parameters Measles Parotitis Rubella Diphtheria Hepatitis B HR (95%CI) р HR (95%CI) р HR (95%CI) р HR (95%CI) р HR (95%CI) Р soJIA, yes 1.84 (0.84; 4.03) 0.128 1.43 (0.53; 3.95) 0.492 0.99 (0.05; 18.6) 0.995 2.04 (0.91;4.59) 0.08 2.52 (1.27; 5.0) 0.008 GCS, yes 1.54 (0.91; 2.61) 0.104 0.31 (0.45;1.84) 0.799 0.736 (0.11; 4.88) 0.736 1.89 (1.1; 3.24) 0.02 1.34 (0.77; 2.32) 0.295 МТХ, yes 0.86 (0.39; 1.88) 0.703 1.55 (0.49; 4.88) 0.453 1.53 (0.08; 28.64) 0.776 2.02 (0.71; 5.76) 0.187 0.6 (0.31; 1.15) 0.122 Biologics, yes 2.02 (1.22; 3.32) 0.006 1.76 (0.98; 3.15) 0.057 2.26 (0.5; 9.87) 0.293 1.67 (0.99; 2.8) 0.053 1.2 (0.75; 1.92) 0.453 &gt;1 biologics, consequent, yes 1.57 (1.13; 2.2) 0.007 1.4 (0.93; 2.09) 0.104 1.82 (0.71; 4.7) 0.213 1.4 (0.98; 2.0) 0.062 1.11 (0.78; 1.58) 0.572 Incomplete vaccination, yes 2.02 (1.02; 4.0) 0.042 6.25 (2.13; 17.9) 0.00008 na * na * 2.39 (1.18; 4.85) 0.016 na * na * Conclusion: Children with JIA may have lower anti-vaccine antibodies levels and required routine check, especially in children with incomplete vaccination, biologics, systemic arthritis and long-term methotrexate treatment. Funding statement: Footnotes: CI confidence interval, GCS glucocorticosteroids, HR hazard ratio, MTX methotrexate, na not applicable, soJIA systemic onset of juvenile idiopathic arthritis. * Data were not calculated due to a small number of patients with a non-protective level of antibodies against rubella and no patients with incomplete vaccination against hepatitis This work was supported by the Russian Foundation for Basic Research (grant № 18-515-57001). Disclosure of Interests: None declared