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.
What to do with methotrexate dosing in RA, relative to influenza vaccination?
Aug 5, 2018