Breaking News
February 24, 2018 - UCLA researchers use fluorescent colored proteins to trace origin of heart cells
February 24, 2018 - Home Routines Can Boost a Child’s Readiness for School
February 24, 2018 - FDA Investigating Misuse, Abuse of Gabapentinoids
February 24, 2018 - Scientists find key proteins control risk of osteoarthritis during aging
February 24, 2018 - Izon announce the launch of the qEV2 and qEV10 Exosome Isolation columns
February 24, 2018 - New CSIRO technology can create clean drinking water
February 24, 2018 - Treating sleep-disordered breathing may improve prognosis of heart failure patients
February 24, 2018 - More boys begin school a year late than girls, study finds
February 24, 2018 - Early life exposure to green space could have beneficial effects on cognitive function
February 24, 2018 - Joint Surgery: Aspirin Equals NOAC for Post-Acute VTE Prevention
February 23, 2018 - Scientists identify new marker of arthritis in mice
February 23, 2018 - Beetroot juice supplements may benefit patients with heart failure
February 23, 2018 - New study identifies novel molecular biomarkers of preeclampsia
February 23, 2018 - Researchers discover new link between gut bacteria and obesity
February 23, 2018 - Aimmune Therapeutics’ Pivotal Phase 3 PALISADE Trial of AR101 Meets Primary Endpoint in Patients With Peanut Allergy
February 23, 2018 - Improving Glaucoma Care: Ophthalmology Times
February 23, 2018 - Preventing dementia: The promising, the disappointing and the inconclusive
February 23, 2018 - Duke researchers show how to retrain immune system of peanut-allergy mice
February 23, 2018 - Older males could live longer with light intensity exercise, study suggests
February 23, 2018 - C-sections and gut bacteria linked to childhood obesity risk
February 23, 2018 - Asthmatics have lower degree of DNA methylation in certain immune cells
February 23, 2018 - Uniforms coated with copper nanoparticles could reduce spread of hospital infections
February 23, 2018 - What Not to Do If You Have Asthma and Want to Get Pregnant
February 23, 2018 - Deep brain stimulation may be promising Alzheimer’s treatment
February 23, 2018 - AMSBIO offers new PARPtrap Assay Kit
February 23, 2018 - New study identifies mechanisms to lengthen egg viability in worms
February 23, 2018 - Interventions to improve self-concept could be critical in treating mental health patients
February 23, 2018 - Few minutes of physical activity may lower risk of death in older men, research suggests
February 23, 2018 - Modifications in HIV test enable rapid detection of Zika virus, study states
February 23, 2018 - Could Hackers Target Heart Devices?
February 23, 2018 - Kids’ Mental Health Status Not a Factor in Gun Storage
February 23, 2018 - Revellers ready for festival drug checks, study finds
February 23, 2018 - Stanford researchers explore how enzyme changes and becomes antibiotic-resistant
February 23, 2018 - Scientists decode molecular structure of healthy huntingtin protein
February 23, 2018 - Efficacy of cancer immunotherapy increased by deactivating tumor defence mechanism
February 23, 2018 - Epigenetic changes due to normal aging process linked to cancer risk
February 23, 2018 - Evaluations of Medicaid experiments by states, CMS are weak, GAO says
February 23, 2018 - Biomarkers ID’d for Anesthesia-Related Neural Damage
February 23, 2018 - Study reveals how kidney disease happens
February 23, 2018 - Iron deficiency early in life can have long-lasting consequences for the brain
February 23, 2018 - High protein diet reduces risk of Alzheimer’s disease, research finds
February 23, 2018 - Research extends powerful capabilities of MRI to nanometer scale
February 23, 2018 - Scientists show that cutting-edge technique can efficiently sort nano-sized particles
February 23, 2018 - Dornier’s new laser innovation delivers confidence to glide through deflected scopes
February 23, 2018 - Neurocrine Biosciences Will File New Drug Application for Opicapone for Parkinson’s Disease Based on Existing Pivotal Clinical Trial Data
February 23, 2018 - Bariatric Surgery Enabled Stopping Diabetes Meds
February 23, 2018 - C-sections and gut bacteria increase risk of childhood obesity
February 23, 2018 - Busting myths about diet and kidney stones
February 23, 2018 - Reformulating vaccines to prevent relapse
February 23, 2018 - Prophylactic use of haloperidol does not reduce delirium burden
February 23, 2018 - Higher prevalence of kidney stones in Southern United States
February 23, 2018 - Lithotripsy has revolutionized modern kidney stone management
February 23, 2018 - Researchers describe important step toward gene therapy for patients with Sandhoff disease
February 23, 2018 - Pain Therapeutics Resubmits New Drug Application for Remoxy ER, an Abuse-Deterrent, Extended-Release Drug Candidate for the Treatment of Chronic Pain
February 23, 2018 - Combo Therapy Highly Active in Untreated RCC
February 23, 2018 - Boosting a key protein to help bones that won’t heal
February 23, 2018 - Advanced method holds promise for substantial improvements in breast cancer diagnosis
February 23, 2018 - MRI and machine learning could predict whether OCD patients will benefit from treatment
February 23, 2018 - Comparing low-fat and low-carb diets finds little difference
February 23, 2018 - FDA Alert: Clarithromycin (Biaxin): Drug Safety Communication
February 23, 2018 - Out of Limbo Into Bomb Scare
February 23, 2018 - Patients who achieve short-term weight loss before bariatric surgery have better outcomes
February 23, 2018 - Beetroot may reduce kidney failure risk after heart x-ray, research reveals
February 23, 2018 - Sleep disruptions in menopause correlated with hot flashes and depression
February 23, 2018 - Scientists discover new treatment approach to curb severe myocarditis
February 23, 2018 - ‘Click chemistry’ approach may improve disease-fighting properties of drugs
February 23, 2018 - NIGHTSEA and EMS team up to offer KEY Award in fluorescence stereo microscopy
February 23, 2018 - Calorie restriction improves intestinal-tissue regeneration after injury
February 23, 2018 - Tobacco Kills, No Matter How It’s Smoked: Study
February 23, 2018 - Q&A: Avindra Nath, MD | Medpage Today
February 23, 2018 - Adherence to sleep apnea treatment affects risk of hospital readmission
February 23, 2018 - Zika virus could be alternative for treatment of aggressive brain cancer
February 23, 2018 - Carbon monoxide enhances efficacy of antibiotic against stomach infection
February 23, 2018 - Study sheds light on biological mechanisms that drive rare pediatric neurogenetic disorders
February 23, 2018 - MSD and Ferring Pharmaceuticals Complete Largest Ever Clinical Trial in Postpartum Haemorrhage
February 23, 2018 - Portable ultrasound can help better detect fluid in the lungs of patients with end-stage kidney disease
February 23, 2018 - Postnova AF2000 system offers reliable characterization of trace metal colloid distribution in the environment
February 23, 2018 - Pioneering study may pave way for effective painkillers to treat neuropathic pain
February 23, 2018 - Research opens up new avenue to minimize risks of transplants
February 22, 2018 - Cabozantinib Active in Advanced Thyroid Cancer
Methotrexate drug holiday improves flu vaccine efficacy in rheumatoid arthritis patients

Methotrexate drug holiday improves flu vaccine efficacy in rheumatoid arthritis patients

image_pdfDownload PDFimage_print

People with RA who stop taking methotrexate treatment for just two weeks after they have a seasonal flu shot can improve the vaccine’s efficacy without increasing RA disease activity, according to new research findings presented this week at the 2017 ACR/ARHP Annual Meeting in San Diego.

Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Methotrexate, a widely used immunosuppressant, can lower vaccine efficacy in people with RA. So researchers in Seoul, Republic of Korea, set out to investigate whether patients with RA could improve their response to influenza vaccinations by temporarily pausing methotrexate use for two weeks after their flu shot.

“RA patients are more susceptible to infections, including seasonal flu, due to their underlying abnormal immune function and the treatment-associated immune suppression,” said Jin Kyun Park, MD, Assistant Professor of Medicine at Seoul National University Hospital, and a lead author of the study. “RA patients taking methotrexate are at even higher risk of infection and infection-related complications, so it’s important that they be vaccinated against preventable infectious diseases. However, the immune suppression decreases vaccine response. To overcome this shortcoming, our group has been working on a novel immunization protocol for RA patients to optimize vaccine response, including increasing immunogenicity of flu vaccines.”

In this prospective, multicenter, randomized, parallel-group trial conducted from October 2016 to January 2017, 316 RA patients who were taking a stable methotrexate dose were randomly assigned to two groups: 156 continued their regular methotrexate and 160 discontinued their dose for two weeks after receiving their flu shot. All participants were vaccinated with a seasonal, quadrivalent influenza vaccine containing H1N1, H3N2, B-Yamagata and B-Victoria.

The study’s primary outcome measurement was the frequency of a satisfactory response to the vaccine, which was defined as the patients having a fourfold or greater increase in hemaglutination inhibition (HI) antibody titer at four weeks after vaccination against two or more vaccine strains. They also measured seroprotection rate and fold-change in antibody titers relative to baseline in geometric mean titer.

The researchers found that 75.5 percent of the patients who temporarily discontinued their methotrexate dose achieved a satisfactory vaccine response compared to 54.5 percent of patients who continued their regular dosing. After vaccination, the seroprotection rate was higher for all four antigens measured in the group who held off methotrexate for two weeks than those who continued. The RA patients who paused their methotrexate dose after vaccination also achieved a higher increase of H1 antibody titer in geometric mean titer for each antigen. All patients in the study tolerated the vaccine well. Disease activity after vaccination was the same in both patient groups.

“The findings of this study have several potential clinical implications. First, we show a novel, effective, but simple way to improve vaccine response in RA patients who take methotrexate. Holding methotrexate for two weeks after vaccination improved vaccine response significantly without increasing disease activity. Therefore, patients should be advised to hold methotrexate for two weeks after vaccination,” said Dr. Park. “This approach can be applied to other vaccines, such as pneumonia or zoster. Also, despite the well-known clinical experience that joint symptoms improve three to six weeks after starting methotrexate, our findings indicate that the drug has immediate effects on immune response. Short-term methotrexate discontinuation could be considered in situations of immunologic challenges such as infections or surgery.”

This study only assessed the effect of a temporary methotrexate discontinuation on the vaccine’s immunogenicity, meaning antibody production, after flu shot, said Dr. Park.

“Since antibody production does not always guarantee immune protection, further studies are needed to address as to whether the increased immunogenicity by holding methotrexate for two weeks can prevent flu infection,” he added.


Explore further:
Studies reveal how shingles vaccine should be used in arthritis patients

Provided by:
American College of Rheumatology

Tagged with:

About author

Related Articles