Two-week methotrexate discontinuation helps to improve the SARS-CoV-2 vaccine efficacy in RA patients

Findings of a randomized clinical trial published in the Annals of Rheumatic Diseases have concluded that the 2-week methotrexate withdrawal following Sinovac-CoronaVac vaccine dose helps to improve the anti-SARS-CoV-2 immunogenicity.

Previous studies have noted that patients receiving rituximab, abatacept, methotrexate and glucocorticoids have reduced immunogenicity to COVID-19 vaccines. Hence, temporary withdrawal of immunosuppressant has been suggested as a strategy to enhance the vaccine immunogenicity in such patients. The present single-centre, prospective study carried out the immunogenicity evaluation in 60 subjects in the MTX-hold and 69 subjects in the MTX-maintain group. The researchers have noted that the rate of seroconversion was significantly higher in the MTX-hold group (n=37) as opposed to the MTX-maintain group (n=55, P=0.019), with parallel increase in geometric mean titers (P=0.006). The neutralizing antibody positivity (p=0.217) and the rates of D28 flare were comparable (P=0.122) between the groups.

The present study is touted as the first one reporting that the 2-week MTX withdrawal after each 28-day interval of the vaccine dose helps in enhancing the anti-SARS-CoV-2 immunogenicity. The increased flare rates (Clinical Disease Activity Index >10) noted following the second dose of vaccine could be due to reduced time interval between 2 vaccine doses. Moreover, the study underscore the recommendation of temporary MTX withdrawal following Sinovac-CoronaVac vaccine in patients with RA under close disease activity surveillance.

Reference: Araujo CSR, Medeiros-Ribeiro AC, Saad CGS, et al. Two-week methotrexate discontinuation in patients with rheumatoid arthritis vaccinated with inactivated SARS-CoV-2 vaccine: a randomised clinical trial. Ann Rheum Dis. 2022;81(6):889-897.