Impact of Temporary Methotrexate Discontinuation for 2 Weeks on Immunogenicity of Seasonal Influenza Vaccination in Patients with Rheumatoid Arthritis: A Randomised Clinical Trial

Park JK, Lee YJ, Shin K, Ha YJ, et al.  Ann Rheum Dis. 2018 Mar 23. pii: annrheumdis-2018-213222. [CrossRef]  [PubMed]

Rheumatoid arthritis (RA) is a common disease and methotrexate (MTX) is often used to treat RA. The present study examined whether a 2-week methotrexate (MTX) discontinuation after vaccination improves the efficacy of seasonal influenza vaccination in patients with rheumatoid arthritis (RA). In this prospective randomized parallel-group multicenter study, patients with RA on stable dose of MTX were randomized to continue MTX or to hold MTX for 2 weeks after seasonal influenza vaccination. The primary outcome was frequency of satisfactory vaccine response defined as greater than or equal to fourfold increase of hemagglutination inhibition antibody titer at 4 weeks after vaccination against ≥2 of four vaccine strains. The 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). Although it is late in influenza season in the US, this study suggests that a temporary MTX discontinuation for 2 weeks after vaccination improves the immunogenicity of seasonal influenza vaccination in patients with RA without increasing RA disease activity.