Monday, 11 Dec 2017

You are here

Suspending Methotrexate for Influenza Vaccination

Vaccinating our rheumatoid arthritis patients against influenza every year is a safety priorty. However immunosuppressive therapies pose a challenge to vaccine administration as their use can hamper vaccine immunogenicity. The current issue of Annals of Rheumatic Disease published the findings of a prospective single-center randomized parallel group study looking at the effects of temporarily discontinuing methotrexate on response to the seasonal trivalent influenza vaccine in RA patients living in Seoul, Korea.

Patients who were on a stable dose of methotrexate were randomized into one of 4 groups: 1) continued methotrexate, 2) held methotrexate for 4 weeks before vaccination, 3) held methotrexate for 2 weeks before and 2 weeks after vaccination, and 4) held methotrexate for 4 weeks after vaccination. Patients could continue taking prednisolone equivalent up to 10 mg daily. The primary endpoint was satisfactory vaccine response after 4 weeks, defined by a ≥4-fold increase in haemaglutination inhibition (HI) antibody titers. 

The per-protocol population included 199 patients across the four groups. They found that group 3 achieved higher satisfactory vaccine response against all 3 viral antigens compared to group 1 (51.0% vs 31.5%, p=0.044). The vaccine was well tolerated in all patients. 30% experienced an RA flare which was more common in groups 2 and 3 but not of statistical significance. 

While the authors were unable to enroll enough patients to meet their target due to short enrollment period (thus rendering this study underpowered), it still has important clinical implications and suggests that temporarily discontinuing methotrexate 2 weeks before and 2 weeks after influenza vaccination can significantly improve vaccine immunogenicity. It is unclear if the same result can be expected for patients with active RA. Also, further studies are needed to determine if this effect will result in lower incidence of influenza. 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

J&J Hit with a $247 Million Verdict over Metal-on-Metal Hip Replacements

Reuters reports that a federal jury has ordered Johnson & Johnson and its DePuy Orthopaedics division to pay $247 million settlment to six patients who suffered from its defective Pinnacle, metal-on-metal, hip implants. in the US. J&J says it will  appeal this decision.

These implants were associated with tissue necrosis, bone erosion and other injuries due to implant design.

Thiopurines and Anti-TNF drugs in IBD Associated with Increased Lymphoma Risk

JAMA presents a French report on the cancer risk of thiopurine or tumor necrosis factor inhibitor (TNFi) use in adult patients with inflammatory bowel disease (IBD) and finds a raised risk for lymphoma in IBD compared to those not treated with these agents.  (Citation source https://buff.ly/2z04f9h)

Cardiovascular Events: Allopurinol vs. Febuxostat

In the registration trials for febuxostat there were concerns about a cardiovascular (CV) safety signal. In studies of the effect of allopurinol on CV risk/events allopurinol has found to be protective so whether febuxostat is different is a point to clarify.

Low-dose Bactrim Safe with Methotrexate in AAV

A high proportion of GPA patients receive pneumocystis prophylaxis, usually with TMP-SMX (Bactrim), and drug interactions are always a concern.  

NSAID and Opioid Adverse Event Reports from MedWatch

One-third of adults in the USA experience chronic pain and take prescription nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or opioids. This report from the MedWatch system shows that 20% of reports were associated with death, with near equal contribution by NSAIDs, opioids and combination (NSAIDs plus opioids).