Is rheumatoid arthritis associated with a declined immunogenicity of influenza vaccination? A systematic review and meta-analysis

<b>Objective:</b> To determine whether immunogenicity and safety of influenza vaccination in rheumatoid arthritis (RA) patients are significantly different from those in healthy population. <b>Methods:</b> PubMed, MEDLINE, Embase, Cochrane Library and Web of Science were searched on 31 August 2016. Studies were included when they met the inclusion criteria. Two reviewers independently extracted data on study characteristics, methodological quality and outcomes. The primary outcome was seroprotection (SP) rate after immunization. <b>Results:</b> 13 studies were included. The SP rates did not significantly differ between the RA patients and healthy controls for the H3N2 (RR = 0.96, 95% CI, 0.82 to 1.13, p = 0.64) and B strain (RR = 0.95, 95% CI 0.84 to 1. 08, p = 0.44). Nevertheless, RA was associated with a significant decrease of SP rate for the H1N1 strain (RR = 0.72, 95% CI 0.60 to 0.86, p <b>Conclusions:</b> The immunogenicity was significantly different between RA patients and the healthy controls for H1N1 strain, but not for H3N2 or B strains. Adverse event rates were higher in RA patients. Adjuvant and special kinds of immunosuppressive biologics may play an important role in immunogenicity of inactivated influenza vaccines for RA patients.

**研究目的**：明确类风湿关节炎（rheumatoid arthritis, RA）患者接种流感疫苗的免疫原性与安全性是否与健康人群存在显著差异。**研究方法**：于2016年8月31日检索PubMed、MEDLINE、Embase、Cochrane Library及Web of Science数据库，纳入符合纳入标准的相关研究；由两名评价员独立提取研究特征、方法学质量及结局指标数据，本研究的主要结局指标为免疫接种后的血清保护率（seroprotection, SP）。**研究结果**：共纳入13项研究。针对H3N2亚型与B型毒株，RA患者与健康对照组的血清保护率无显著差异（H3N2：相对风险RR=0.96，95%置信区间CI：0.82~1.13，p=0.64；B型毒株：RR=0.95，95%CI：0.84~1.08，p=0.44）。然而，RA与H1N1亚型的血清保护率显著降低相关（RR=0.72，95%CI：0.60~0.86，p<[原文此处统计信息不完整]）。**研究结论**：针对H1N1亚型，RA患者与健康对照组的免疫原性存在显著差异，但H3N2及B型毒株无此差异。RA患者的不良反应发生率更高；佐剂及特殊类型的免疫抑制生物制剂可能对RA患者接种灭活流感疫苗的免疫原性发挥重要作用。