BRUGES, BELGIUM – A vaccine to prevent human papilloma virus infection, thereby limiting the risk for cervical cancer, has been found to be safe and effective in girls with juvenile idiopathic arthritis.
No changes in disease activity or differences in the girls’ ability to mount healthy antibody titers compared with healthy controls occurred, according to investigator Dr. Marloes Heijstek.
However, while the vaccine was also shown not to influence disease activity in girls with systemic lupus erythematosus (SLE) and juvenile dermatomyositis (JDM), these groups did not mount antibody titers comparable to those seen in girls with juvenile idiopathic arthritis (JIA) and healthy controls, suggesting that the vaccine may offer girls with SLE or JDM less protection against acquiring cancer-causing types of human papilloma virus (HPV).
Even in JIA, the duration of protection remains to be determined and may be shorter than in healthy controls, investigators cautioned.
These findings come from a Dutch study of 58 patients with rheumatic disease and 51 healthy controls (Pediatr. Rheumatol. 2011;9[suppl. 1]:O41 ). Dr. Heijstek of the University Medical Center Utrecht (the Netherlands) collaborated on the ongoing study with principal investigator Dr. Nico M. Wulffraat, also of UMC Utrecht. Dr. Heijstek and Dr. Wulffraat also collaborated on an earlier safety study of measles, mumps, and rubella vaccine in JIA patients (Ann. Rheum. Dis. 2007;66:1384-7).
Dr. Heijstek’s HPV vaccine study enrolled girls with rheumatic disease who had been immunized with the bivalent HPV 16/18 vaccine Cervarix as part of a national program in the Netherlands that aims to vaccinate starting at age 12, before the girls are likely to be sexually active, in three doses at 0, 1, and 6 months, and followed up a year after vaccination. Study subjects and controls were between the ages of 12 and 18. Patients enrolled had JIA (n = 45), JDM (n = 5), or SLE (n = 8). Some of the subjects were taking medication to manage their disease at the time of vaccination. Specifically, 42% of JIA patients and 40% of JDM patients were taking methotrexate; 24% of JIA patients were taking anti-TNF medications.
The percentage of patients able to mount an immunological response to vaccination was shown to be the same in patients and controls, but geometric mean antibody titers for HPV16 were found to be lower in JIA (5,119 LU/mL), SLE (1,461 LU/mL), and JDM patients (3,233 LU/mL) compared with controls.
Geometric mean antibody titers for HPV18 were seen as similar in JIA patients and controls (2,764 LU/mL vs. 2,522 LU/mL). However, SLE and JDM patients showed markedly lower geometric mean antibody titers. Methotrexate use did not lower vaccine responses. One JDM patient did not seroconvert, Dr. Heijstek said. That patient was on both methotrexate and anti-TNF for disease control.
The group as a whole had fairly low, stable disease activity, Dr. Heijstek explained. However, this was not part of the enrollment criteria. When patients have high disease activity, they or their parents often fear a flare of disease due to vaccination or they have the general feeling that it is better to postpone the vaccination until the disease is stable, she told attendees at the congress.
The median juvenile arthritis disease activity score (JADAS)-27 did change considerably between visits (1.9-2.5), but JADAS-27 was significantly elevated at 7 months (P = .001) due to one outlier. SLE and JDM disease activity remained similar.
Days before Dr. Heijstek’s presentation, Dr. Wulffraat provided a background discussion on vaccinations in children with rheumatic diseases. Dr. Wulffraat and Dr. Heijstek’s investigation of MMR vaccine in JIA patients had shown the vaccine not to cause rheumatic disease flare ups or viral disease, and methotrexate use did not appear to affect antibody response.
What is remains unknown is how durable any vaccine protection is in children with rheumatic disease, according to Dr. Wulffraat. Longer study will be required to determine how long the titers persist, and whether they are protective in children on biological therapies such as anti-TNF inhibitors.
Neither Dr. Wulffraat nor Dr. Heijstek disclosed conflicts of interest related to their findings.