Medicine Matters rheumatology

December 9, 2022: Study findings presented at ACR Convergence 2022 in Philadelphia, Pennsylvania, USA, indicated that discontinuation of mycophenolate mofetil for at least 10 days is associated with an improved antibody response to vaccination relative to continuing treatment. No increase in flare risk was seen with mycophenolate discontinuation in the study.

June 30, 2022: The VROOM trial demonstrated that temporarily discontinuing methotrexate for 2 weeks following administration of a COVID-19 booster vaccine doubled the antibody response 4 weeks later, and this enhanced response was sustained at 12 weeks. However, this came at the cost of an increased flare risk. 

June 9, 2022: Results from two studies – MIVAC I and MIVAC II – suggest that pausing methotrexate after the second, but not the first, dose of a COVID-19 vaccine may provide the best balance between antibody response and risk for flare. This research was presented at the EULAR 2022 Congress in Copenhagen, Denmark.

May 12, 2022: Findings from two studies indicated that the type of immunomodulatory therapy, and whether agents are used alone or in combination, may impact how well patients respond to COVID-19 vaccines. The authors of the first study identified anti-CD20 therapy, sphingosine 1-phosphate receptor modulators, and mycophenolate mofetil–corticosteroid combination therapy as being associated with reduced seroconversion rates, while the second study found associations for abatacept, Janus kinase inhibitors, and TNF inhibitors.

March 8, 2022: The CoronavRheum randomized controlled trial showed that temporary discontinuation of methotrexate for 2 weeks after each dose of the Sinovac inactivated SARS-CoV-2 vaccine (CoronaVac) may improve antibody responses to vaccination. However, methotrexate withdrawal was associated with increased flare risk, leading the investigators to conclude that the strategy “requires close surveillance and shared decision making.”

October 13, 2021: A study of 113 people with RA or PsA treated with JAK inhibitors found that the majority (88%) produced antibody responses to COVID-19 vaccination. People aged 65 years and older and those on upadacitinib were less likely to generate an antibody response than other patients.

July 14, 2021: UK research by Catherine Smith (King’s College London) and colleagues found that treatment with methotrexate may dull the humoral, but not cellular, immune response to the first dose of the Pfizer–BioNTech (BNT162b2) vaccine. On the other hand, targeted biologics were not associated with an impaired immune response in the study. Similarly, Serena Bugatti (Fondazione IRCCS Policlinico San Matteo, Pavia, Italy) report in a letter to the Annals of the Rheumatic Diseases that methotrexate, but not anticytokine therapy, was associated with impaired immunogenicity to a single dose of the same vaccine in a study of 140 people with inflammatory arthritis.

May 26, 2021: Study findings from Jose Scher (New York University Langone Health, USA) and colleagues suggested that methotrexate treatment may be associated with a blunted humoral and cell-mediated immune response in patients with inflammatory diseases. The researchers suggest that strategies such as additional vaccine doses or temporary methotrexate discontinuation may be required to improve vaccine effectiveness in methotrexate-treated patients.