POS1293 RISK FACTORS OF NON-PROTECTIVE LEVELS OF ANTIBODIES TO VACCINES IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Abstract

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<0.05) and increased applying of the biologics (76% vs 52%, p<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<0.05) and diphtheria (38% vs 61%, p<0.01), longer duration of methotrexate 3.3 [1.4; 6.7] vs 1.8 [1.0; 2.9] years, p<0.01) and biologic treatment 3.1 [1.1; 5.4] vs 0.9 [0.0; 1.9] years, p<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.ParametersMeaslesParotitisRubellaDiphtheriaHepatitis BHR (95%CI)рHR (95%CI)рHR (95%CI)рHR (95%CI)рHR (95%CI)РsoJIA, yes1.84 (0.84; 4.03)0.1281.43 (0.53; 3.95)0.4920.99 (0.05; 18.6)0.9952.04 (0.91;4.59)0.082.52 (1.27; 5.0)0.008GCS, yes1.54 (0.91; 2.61)0.1040.31 (0.45;1.84)0.7990.736 (0.11; 4.88)0.7361.89 (1.1; 3.24)0.021.34 (0.77; 2.32)0.295МТХ, yes0.86 (0.39; 1.88)0.7031.55 (0.49; 4.88)0.4531.53 (0.08; 28.64)0.7762.02 (0.71; 5.76)0.1870.6 (0.31; 1.15)0.122Biologics, yes2.02 (1.22; 3.32)0.0061.76 (0.98; 3.15)0.0572.26 (0.5; 9.87)0.2931.67 (0.99; 2.8)0.0531.2 (0.75; 1.92)0.453>1 biologics, consequent, yes1.57 (1.13; 2.2)0.0071.4 (0.93; 2.09)0.1041.82 (0.71; 4.7)0.2131.4 (0.98; 2.0)0.0621.11 (0.78; 1.58)0.572Incomplete vaccination, yes2.02 (1.02; 4.0)0.0426.25 (2.13; 17.9)0.00008na*na*2.39 (1.18; 4.85)0.016na*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 hepatitisThis work was supported by the Russian Foundation for Basic Research (grant № 18-515-57001).Disclosure of Interests:None declared