Getting a Flu Shot? Talk to Your Doctor About Pausing Methotrexate

Almost everyone living with rheumatoid arthritis (RA) is probably familiar with methotrexate – an immunosuppressant that is widely used to control RA disease activity. But because methotrexate works by suppressing your immune system, unfortunately it may also reduce the effectiveness of vaccines. This can be a problem when people with RA go to get a flu shot, since we’re already more susceptible to catching the flu just by living with RA.

But a new study presented at the 2017 American College of Rheumatology (ACR) Annual Meeting in San Diego, California may offer a solution to this conundrum. The study was led by Dr. Jin Kyun Park, Assistant Professor of Medicine at Seoul National University Hospital in the Republic of Korea. Researchers decided to investigate whether patients living with RA could have an improved response their flu vaccine by temporarily pausing methotrexate use for two weeks after receiving the shot.

Here’s how the study worked: researchers started with 316 patients, all taking a stable dose of methotrexate to help control their RA. These patients were randomly assigned to two groups. The first group continued their regular methotrexate dose after receiving their flu shot. The second group discontinued their methotrexate for two weeks after receiving their flu shot.

Afterwards, the researchers looked at whether each patient had a satisfactory response to the vaccine using various measures. Of the patients who continued their regular methotrexate dosing, 54.5% achieved satisfactory vaccine response. In comparison, 75.5% of the patients who temporarily paused their methotrexate dose achieved a satisfactory vaccine response.

There was also more evidence suggesting that the group who took the two-week break from methotrexate had better results than the group who continued with their regular dosing schedule. For example, when a person is given a vaccine, seroprotection is an antibody response capable of preventing future infection. In this study, the seroprotection rate was higher for all four antigens measured in the group that paused methotrexate than in the group that continued their regular dose.

Of course, you may wonder whether pausing methotrexate had a negative impact on RA disease activity. Luckily, in this study, the researchers found that the two-week methotrexate break did not lead to a change in RA disease activity.

These results present a new approach for RA patients when it comes to flu shots. While obviously each of us will need to discuss this decision with our own doctors, Dr. Park concludes that pausing methotrexate for two weeks after receiving a flu vaccine may allow patients to achieve a better immune response without risking an increase in RA disease activity. This data is also exciting because it’s possible this approach could be applied to other vaccines, such as pneumonia or zoster. A similar approach could also be considered temporarily in cases of infections or surgery.

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