What to do with methotrexate dosing in RA, relative to influenza vaccination?

Korean researchers have conducted a randomised study of people with RA on stable dose of MTX who were randomly assigned continue MTX or to hold MTX for 2 weeks after quadrivalent seasonal influenza vaccination. The primary outcome was frequency of satisfactory vaccine response, defined as ≥ to fourfold increase of haemagglutination inhibition 4 weeks after vaccination. The secondary endpoints included seroprotection (ie, HI titre ≥1:40) rate, and fold change in antibody titres. The modified intention-to-treat population included 156 patients in the MTX-continue group and 160 patients in the MTX-hold group. More patients in MTX-hold group achieved satisfactory vaccine response than the MTX-continue group (75.5% vs 54.5%, p<0.001). Seroprotection rate was higher in the MTX-hold group than the MTX-continue group for all four antigens (H1N1, H3N2, Yamagata and B-Victoria). Temporary MTX discontinuation for 2 weeks after vaccination was found to improve the immunogenicity of seasonal influenza vaccination in patients with RA without increasing RA disease activity.