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Hold the Methotrexate for One Week

In 2018, Park et al showed optimal responses to influenza vaccination in rheumatoid arthritis (RA) patients was best achieved by holding methotrexate (MTX) for 2 weeks following immunization, with improved humoral responses. Now, a followup trial suggests that equivalent results are had by holding MTX for only 1 week with the "flu" vaccine.

A research letter published in Arthritis & Rheumatology reports the final results of their open-label, prospective, multicenter study that examined if temporary interruption of weekly MTX for 1 week after seasonal  influenza vaccination is non-inferior to a 2 week suspension of MTX.

A total of 184 RA patients on weekly MTX were randomized to either a 1- week hold group (n=92) or a 2-week hold group (n=92). Patients were assessed at baseline, 4 weeks, and 16 weeks after seasonal influenza vaccination.

A satisfactory vaccine response was equally achieved between the 1-week and 2-week hold groups at:

  • 4 weeks (68.9% vs. 75.0%, p = 0.364; difference  6.1%, 95% CI: - 7.1 to 19.3)
  • 16 weeks (78.4% vs. 79.1%, p = 0.915; difference  0.6%, 95% CI: -11.5 to 12.8)
  • Antibody titers against all four strains increased rapidly by 4 weeks and remained elevated throughout the 16-week study.

These results were unaffected by MTX dose and the temporary suspension of MTX had no effect on the disease activity  score (DAS28-CRP) nor flare rates at weeks 4 (4.5% vs.12.9%, p = 0.050) or 16 weeks (7.1% vs. 11.8%, p = 0.293) between groups.

The study showed that holding MTX for 1 week is as effective as a 2 week hold after seasonal  influenza vaccination in RA patients on stable doses of MTX.


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