Withholding methotrexate after zoster vaccine ‘shows promise’ in raising humoral response
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WASHINGTON — Patients with autoimmune rheumatic diseases who withhold methotrexate for 2 weeks after receiving the recombinant herpes zoster vaccine demonstrate improved humoral response, according to data presented at ACR Convergence 2024.
“We already know that methotrexate reduces immune response to many vaccines against some different pathogens,” Ana Cristina Medeiros-Ribeiro, MD, of the University of Sao Paulo, in Brazil, told attendees. “We also know that temporary methotrexate discontinuation for a short time after vaccination may enhance vaccine response.”
To assess whether a 2-week methotrexate discontinuation could enhance response to the recombinant herpes zoster vaccine in patients with autoimmune rheumatic diseases, Medeiros-Ribeiro and colleagues conducted a single-center, prospective, randomized, investigator-blinded, interventional study. In all, the analysis included 202 patients with rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, systemic sclerosis and ankylosing spondylitis.
“All included autoimmune rheumatic disease (ARD) patients had disease control for at least 3 months,” Medeiros-Ribeiro said.
Among the participants, 95 withheld methotrexate for 2 weeks following vaccination while 107 continued with treatment.
The primary endpoint was the enhancement of immune response, defined by geometric mean titers (GMT), according to Medeiros-Ribeiro. Rate of disease flares also underwent analysis.
Results after the second dose of the vaccine showed GMT response rates of 9.9 (P < .001) among patients who withheld methotrexate and 5.6 (P < .001) in those who maintained.
“When we observed the geometric mean titers, we observed that both groups increased their titers,” Ribeiro said. “However, after the second dose, the methotrexate hold group showed higher antibody titers in comparison to the methotrexate maintain patients.”
Meanwhile, in patients aged 60 years or older, GMT levels were 9.4 (P < .001) among patients who withheld methotrexate after the second vaccine dose, vs. 4.2 (P < .001) for those who maintained.
“The titers were higher in the methotrexate hold group compared to the maintain group,” Ribeiro said.
For patients aged younger than 60 years, although both groups reported increased antibody titers, the difference between the hold and maintain groups failed to reach statistical significance, according to Medeiros-Ribeiro.
Similarly, disease flare rates were 10.8% among those who withheld methotrexate, compared with 13% for those who maintained, which Medeiros-Ribeiro noted also did not reach statistical significance.
“A methotrexate hold strategy shows promise in enhancing vaccine immunogenicity in ARD patients vaccinated with a recombinant zoster vaccine,” she said.
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Medeiros-Ribeiro ACM. Abstract #2612. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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