Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2023
But just a one-week hiatus might be enough.
In 2017, Korean researchers found that methotrexate interferes with the serological response to influenza vaccine (Ann Rheum Dis 2017; 76: 1559-1565). Since then, rheumatologists routinely have suggested stopping the drug for two weeks after patients with stable rheumatoid arthritis are vaccinated. The same group of researchers now investigated whether a shorter hiatus provides the same benefit.
They randomised 153 patients with rheumatoid arthritis (mean age, 58 years; most were women; mean daily dose of methotrexate, about 12.5 mg) to stop taking the drug for either one or two weeks after getting a standard-dose quadrivalent 2021–2022 flu vaccine. Many of the patients were also taking corticosteroids or other antirheumatic drugs, which were continued. One month after vaccination, an overall satisfactory serological response to the vaccine was achieved in about 70% of participants in each group – similar to the 63% response rate among healthy controls. During the first month after vaccination, participants in the two-week group were more likely than those in the one-week group to have rheumatoid arthritis flares (12% vs 5%; p=0.05).
Comment: This study suggests that even a very brief discontinuation of methotrexate will optimise protection afforded by flu vaccine. Whether its findings are clinically meaningful awaits an upcoming analysis of its clinical endpoints. Clinicians are directed to a new American College of Rheumatology (ACR) guideline, which provides updated recommendations on optimising vaccine performance in patients receiving the gamut of immunosuppressive drugs (Arthritis Rheumatol 2023; 75: 333-348). A short summary of the guideline is available on the ACR’s website.
Abigail Zuger, MD
Former Associate Clinical Professor of Medicine, Icahn School of Medicine at Mount Sinai; former Senior Attending Physician, Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York City, USA.
Park JK, et al. A multicenter, prospective, randomized, parallel-group trial on the effects of temporary methotrexate discontinuation for one week versus two weeks on seasonal influenza vaccination in patients with rheumatoid arthritis. Arthritis Rheumatol 2023; 75: 171-177.
This summary is taken from the following Journal Watch titles: General Medicine, Infectious Diseases, Ambulatory Medicine