Stopping Methotrexate for 1 Week After Flu Vaccine May Work as Well as 2 Weeks

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Methotrexate weakens the immune response to vaccines. A recent study showed that if a patient with rheumatoid arthritis was vaccinated against influenza, he could withdraw treatment for one week, instead of two.

A recent study showed that a 1-week hold on methotrexate was equally effective with respect to immediate and long-term influenza vaccine responses in rheumatoid arthritis (RA) patients.

Methotrexate is the first-line therapy for rheumatoid arthritis (RA) due to its efficacy, safety profile, and low cost.

However, responses to pneumococcal and seasonal influenza vaccines, especially novel strain antigens, are greatly reduced. A previous study showed that immunogenicity was improved when patients withheld methotrexate for 2 weeks after receiving the seasonal influenza vaccine. This study aimed to determine whether a one-week hold would work as well.

In this prospective, randomized, parallel-group trial, 178 adult patients with RA were recruited from a tertiary center in South Korea. All met the American College of Rheumatology (ACR) criteria for RA and had been on a constant dose of methotrexate for at least 6 weeks.

Patients received a quadrivalent 2021-2022 seasonal influenza vaccine (H1N1, H3N2, B-Yamagata and B-Victoria strains) followed by methotrexate for 1 week (90 patients) or 2 weeks (88 patients). ) were randomly assigned to hold.

A control group without autoimmune disease served as a reference.

The primary outcome was a positive response 4 weeks after vaccination, defined as a 4-fold or greater increase in antibody titers against at least 2 vaccine strains. Secondary endpoints were positive responses and antibody titers at 4 and 16 weeks post-vaccination.

The proportion of patients achieving a satisfactory vaccine response was similar in the 1-week and 2-week groups at 4 and 16 weeks (69% vs. 75% and 69.6% vs. 70.3%, respectively). Vaccine responses in RA and control patients were similar.

The researchers said they don’t yet know if the strategy will work with other vaccines. They next want to see if this approach can be applied to other disease-modifying therapies and vaccines.

Jin Kyun Park, M.D., chief of rheumatology at Seoul National University Hospital, associate professor at Seoul National University School of Medicine, and lead author of the study, said the main reason for conducting the study was to minimize time without methotrexate. To reduce the likelihood of disease flare-ups.

“Both patients and doctors often don’t know what to do with methotrexate when they need a vaccination, such as the annual flu vaccine or the new COVID-19 vaccine. Skipping methotrexate for a week is skipping two weeks. It is reassuring to know that it is as effective as we do, and that it improves vaccine response without increasing the risk of disease recurrence.” he said in a statement.

The research was presented at ACR Convergence 2022, the ACR’s annual meeting.

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