Temporary MTX suspension improves immunogenicity of influenza vaccines in RA patients
In patients with rheumatoid arthritis (RA), temporary cessation of methotrexate (MTX) treatment for 2 weeks following influenza vaccination appears to improve the immunogenicity of the vaccine without increasing RA disease activity, according to a study.
The study randomly assigned 156 patients to the MTX-continue group and 160 patients to the MTX-hold group (temporary MTX discontinuation for 2 weeks) after receipt of the 2016–2017 quadrivalent seasonal influenza vaccine containing H1N1, H3N2, B-Yamagata and B-Victoria.
The primary outcome was frequency of satisfactory vaccine response, defined as ≥4-fold increase in haemagglutination inhibition (HI) antibody titre at 4 weeks after vaccination. Secondary endpoints included seroprotection rate (ie, HI titre ≥1:40) and fold change in antibody titres.
Significantly more patients in MTX-hold group achieved satisfactory vaccine response than in the MTX-continue group (75.5 percent vs 54.5 percent; p<0.001).
Results for seroprotection rate were also more favourable in the MTX-hold group vs the MTX-continue group for all four antigens (H1N1: difference, 10.7 percent; H3N2: difference, 15.9 percent; B-Yamagata: difference, 13.7 percent; B-Victoria: difference, 14.7 percent).
Finally, patients in the MTX-hold group showed a higher fold-increase in the antibody titres for all four influenza antigens (p<0.05 for all). Change in disease activity was similar between the MTX-continue and MTX-hold groups.
The vaccine was well tolerated, with adverse events profile similar between the MTX-continue and MTX hold groups.
Compared with healthy individuals, patients with RA carry a greater infectious disease burden due to immune dysfunction associated with the underlying autoimmunity and immunosuppressive treatment, researchers said. This increased susceptibility to infection underscores the importance of vaccinating patients for preventable infectious agents and temporary suspending MTX treatment to increase the immunogenicity of vaccines.