ArticleAnnals of the rheumatic diseases2022
Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases.
Article in Annals of the rheumatic diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- The effects of methotrexate on the immune responses to the COVID-19 vaccines in the patients with immune-mediated inflammatory disease: A systematic review of clinical evidence.Transplant immunology · 2023Pooled it
- 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases.Arthritis & rheumatology (Hoboken, N.J.) · 2023Guideline
- 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases.Arthritis care & research · 2023Guideline
- Effect of a 2-week interruption in methotrexate treatment versus continued treatment on COVID-19 booster vaccine immunity in adults with inflammatory conditions (VROOM study): a randomised, open label, superiority trial.The Lancet. Respiratory medicine · 2022Trial
- Trial
- Rapid on-off effects of methotrexate on lymphocytes may facilitate recovery of suppressed vaccine immunogenicity after its short-term methotrexate discontinuation in rheumatoid arthritis.Frontiers in immunology · 2026Article
- Vaccination Update and Specific Concerns for RA.Current rheumatology reports · 2025Review
- Severe Respiratory Infections in Rheumatoid Arthritis Patients: An Observational Study of 528 Patients from a Single University Hospital.Journal of clinical medicine · 2025Article
- [Corona vaccination under immunosuppression].Zeitschrift fur Rheumatologie · 2024Article
- Factors associated with immune responses to SARS-CoV-2 vaccination in individuals with autoimmune diseases.JCI insight · 2024Observational
- Article
- Naturally acquired adaptive immunity toClinical & translational immunology · 2024Article
- COVID-19 Vaccination and Immunosuppressive Therapy in Immune-Mediated Inflammatory Diseases.Vaccines · 2023Review
- Effect of DMARDs on the immunogenicity of vaccines.Nature reviews. Rheumatology · 2023Review
- Susceptibility to COVID-19 and Immunologic Response to Vaccination in Patients With Immune-Mediated Inflammatory Diseases.The Journal of infectious diseases · 2023Article
- Managing Immunosuppression in Vasculitis Patients in Times of Coronavirus Disease 2019.Rheumatic diseases clinics of North America · 2023Review
- Should we stop methotrexate or not for vaccination?RMD open · 2023Article
- Article
- Improvement of humoral immunity by repeated dose-intensified COVID-19 vaccinations in primary non- to low-responders and B cell deficient rheumatic disease patients.Journal of autoimmunity · 2023Article
- Clinical usefulness of testing for severe acute respiratory syndrome coronavirus 2 antibodies.European journal of internal medicine · 2023Review
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Authors and funding
13 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo study the effect of methotrexate (MTX) and its discontinuation on the humoral immune response after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD).
methodsIn this retrospective study, neutralising SARS-CoV-2 antibodies were measured after second vaccination in 64 patients with AIRD on MTX therapy, 31 of whom temporarily paused medication without a fixed regimen. The control group consisted of 21 patients with AIRD without immunosuppressive medication.
resultsPatients on MTX showed a significantly lower mean antibody response compared with patients with AIRD without immunosuppressive therapy (71.8% vs 92.4%, p<0.001). For patients taking MTX, age correlated negatively with immune response (r=-0.49; p<0.001). All nine patients with antibody levels below the cut-off were older than 60 years. Patients who held MTX during at least one vaccination showed significantly higher mean neutralising antibody levels after second vaccination, compared with patients who continued MTX therapy during both vaccinations (83.1% vs 61.2%, p=0.001). This effect was particularly pronounced in patients older than 60 years (80.8% vs 51.9%, p=0.001). The impact of the time period after vaccination was greater than of the time before vaccination with the critical cut-off being 10 days.
conclusionMTX reduces the immunogenicity of SARS-CoV-2 vaccination in an age-dependent manner. Our data further suggest that holding MTX for at least 10 days after vaccination significantly improves the antibody response in patients over 60 years of age.
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