Rheumatoid arthritis

Methotrexate holiday boosts flu vaccine efficacy

People with RA who take a two week methotrexate ‘holiday’ immediately after a flu shot may have increased protection from the flu, new research suggests.

Lead author Jin Kyun Park, Assistant Professor of Medicine at Seoul University Hospital told the limbic that the findings had the potential to be practice changing for rheumatologists but more research was needed.

The prospective trial randomised 316 RA patients to continue their methotrexate or to discontinue their dose for two weeks immediately following their flu vaccine.

The primary outcome of the study was the frequency of a satisfactory response to the vaccine, defined as a fourfold or greater increase in haemaglutination inhibition antibody titre at four weeks after vaccination against two or more vaccine strains.

Results showed that 75.5 percent of the patients who discontinued their methotrexate dose met the study’s primary endpoint compared to 54.5 percent of patients who continued with their regular dose.

The flare rate was 5 percent in the group (DAS28) that continued MTX  compared to 10 percent in the MTX holiday group, but the finding was not statistically significant.

“We show a novel effective but simple way to improve vaccine response in RA patients who take methotrexate,” Dr Park said.

However, he noted that the study had only tested antibody protection and this didn’t necessarily translate into immune protection.

“We measured vaccine titre but titre does not mean real protection… because if you have a high titer you can still get flu infection,” he told the limbic.

“Prospective studies are needed to address whether the increased immunogenicity by holding methotrexate for two weeks can prevent flu infection,” he said.

Commenting on the study, Paul Sufka MD, a rheumatologist with HealthPartners Medical Group and Regions Hospital in St. Paul, Minnesota said the timing of the methotrexate holiday (immediately after the flu jab) was pragmatic and something that could easily be pulled off in the clinic.

He noted, however, that the patients in the study had low disease activity and the findings may not apply to people with high disease activity.

“This [study] may change what we do – at least for people under good control,” he said.

See abstract here.

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