Methotrexate drug holiday improves vaccine efficacy in RA | ACR


  • RSi Communications
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Takeaway

  • Patients with rheumatoid arthritis (RA) who stop taking methotrexate treatment for just 2 wks after they have a seasonal influenza shot can improve the vaccine’s efficacy without increasing RA disease activity. 

Why this matters

  • Methotrexate can lower vaccine efficacy in people with RA. 

Study design

  • Seoul National University Hospital researchers conducted a prospective, multicenter, randomized, parallel-group trial in October 2016 to January 2017.
  • 316 patients with RA taking a stable methotrexate dose were randomly assigned to two groups: 156 continued regular methotrexate and 160 discontinued their dose for 2 wks after receiving their shot.
  • All participants were vaccinated with a seasonal, quadrivalent influenza vaccine containing H1N1, H3N2, B-Yamagata, and B-Victoria.
  • Primary outcome was frequency of satisfactory response to the vaccine, which was defined as the patients having a fourfold or greater increase in hemaglutination inhibition (HI) antibody titer at 4 wk after vaccination against two or more vaccine strains. 

Key results

  • 75.5% of patients who temporarily discontinued methotrexate achieved a satisfactory vaccine response compared to 54.5% of patients who continued regular dosing.
  • After vaccination, the seroprotection rate was higher for all four antigens measured in the group who held off methotrexate for two wks than those who continued.