OP0267 INACTIVATED INFLUENZA VACCINATION DOES NOT ASSOCIATE WITH DISEASE FLARES IN AUTOIMMUNE RHEUMATIC DISEASES: A SELF-CONTROLLED CASE SERIES STUDY USING DATA FROM THE CLINICAL PRACTICE RESEARCH DATALINK

Abstract

Background Concerns about vaccination with the seasonal flu vaccine associating with increased risk of autoimmune rheumatic disease (AIRD) activity, and anecdotal reports of the seasonal flu vaccine triggering diseases such as vasculitis are barriers to flu vaccination in this population1-2. This is despite reports of stable disease activity following flu vaccination provided disease modifying anti-rheumatic drug therapy is continued in the peri-vaccination period3. Previous studies generally include patients with stable disease activity, and as far as we are aware, a real world study evaluating the association between inactivated influenza vaccine (IIV) administration and AIRD activity has not been conducted. Objectives To examine the association between IIV administration and primary care consultation for joint pain, fatigue, rheumatoid arthritis (RA) flare, corticosteroid prescription, and incident vasculitis in people with AIRDs. Methods We undertook within-person comparisons using self-controlled case-series (SCCS). AIRD cases who received IIV and had an outcome of interest in the same influenza cycle, between 1st September of one year and 31st August of the next year, between 2006 and 2016 were ascertained within the Clinical Practice Research Datalink. The influenza cycle (1st September of one year to 31st December of the next year) was partitioned into five exposure periods (1-15 days pre-vaccination, and 0-14, 15-30, 31-60, and 61-90 days post-vaccination), with the remaining time period classified as non-exposed. Incidence rate ratios (IRRs) and 95% confidence intervals (CI) were calculated to compare the frequency of outcomes in different periods. Results Data for 14,928 AIRD cases (69% women, 80% with RA) were included. There was no association between IIV administration and primary-care consultation for RA flare, corticosteroid prescription, and vasculitis (Table 1). Vaccination associated with reduced primary-care consultation for joint pain in the 90-day post-vaccination period (IRR (95%CI) 0.91(0.87-0.94)), and fatigue (IRR (95%CI) 0.40(0.22-0.71)) in the 61-90 days post vaccination (Table 1). Conclusion The administration of IIV was not associated with flare of the underlying AIRD and its association with reduced disease activity warrants further investigation. Nevertheless, these data add to the accumulating evidence to support seasonal influenza vaccination in people with AIRDs.