One-week methotrexate hold as effective as two-week hold after flu vaccine for RA patients
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PHILADELPHIA — Discontinuing methotrexate for 1 week after influenza vaccination offers similar seroprotection as pausing for 2 weeks in patients with rheumatoid arthritis, according to data presented at ACR Convergence 2022.
“We that methotrexate is a very good medication that can treat RA disease activity very well,” Jin Kyun Park, MD, chief of rheumatology at Seoul National University Hospital, associate professor at Seoul National University College of Medicine, in South Korea, said during a press conference at the ACR meeting. “However, as an immunosuppressant, it can also decrease vaccine response. We showed in the past, through randomized clinical trials, that the temporary discontinuation of methotrexate for 2 weeks after vaccination increases vaccine response by 15%.
“However, the temporary discontinuation of any medication is associated with the risk for disease flares,” he added. “We are trying to optimize the duration of methotrexate discontinuation in with RA.”
To analyze whether pausing methotrexate for 1 week after seasonal influenza vaccination is noninferior, in terms of long-term vaccine response, to pausing for 2 weeks in patients with RA, Park and colleagues conducted a prospective randomized parallel-group multi-center non-inferiority trial study. Patients with RA on a stable dose of methotrexate were randomly assigned 1:1 to discontinue for either 1 week or 2 weeks after receiving the quadrivalent 2021-2022 seasonal influenza vaccine containing, H1N1, H3N2, B-Yamagata, and B-Victoria strains.
The primary outcome was the proportion of patients with a satisfactory vaccine response, defined as at least a 4-fold increase in hemagglutination inhibition antibody titers against two or more of the four vaccine strains, 4 weeks following vaccination. Secondary outcomes included positive response and antibody titers at 4 and 16 weeks following vaccination. The researchers included individuals without autoimmune disease as a control group. In all, the modified intention-to-treat population included 90 patients in the 1 week discontinuation group, and 88 in the 2 week discontinuation group.
According to the researchers, the proportion of satisfactory vaccine responses did not differ between the 1- or 2-week discontinuation groups at either at 4 weeks — 68.9% vs. 75%, respectively (P = .364) — or at 16 weeks — 69.6% vs. 70.3% (P = .915). The proportion of patients achieving seroprotection and the rise in antibody titer were also similar between the groups at 4 and 16 weeks. Additionally, vaccine responses among patients with RA and control individuals were similar.
“In order to boost or optimize vaccine response, you can skip one weekly dose of methotrexate after vaccination,” Park said. “This is as effective as withholding it for 2 weeks. What we do in the clinic right now is ask the patient to skip 1 weekly dose, or 2 weekly doses, of methotrexate after any vaccination.”
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Park JK. Abstract 0936. Presented at: ACR Convergence 2022; Nov. 11-14, 2021; Philadelphia (hybrid meeting).
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