TNF-α Drugs Don’t Appear to Affect Vaccine Responses in RA

Hua C, Barnetche T, Combe B, Morel J. Effect of Methotrexate, Anti–Tumor Necrosis Factor α, and Rituximab on the Immune Response to Influenza and Pneumococcal Vaccines in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care & Research. (2014) 66:1016–1026. doi: 10.1002/acr.22246

Methotrexate (MTX) and rituximab (RTX) seem to dampen responses to common immunizations in rheumatoid arthritis (RA) patients -- while tumor necrosis factor-alpha (TNFα) blockers have no apparent effect, according to a new study.

In the first meta-analysis of vaccine response rates in RA patients, French researchers find that MTX lessens the response to pneumococcal vaccines and may impair responses to seasonal flu shots. RTX reduces responses to both.

However, the researchers emphasize that regardless of any treatment effects, vaccines still provide important protection against infection in RA patients.

Despite federal guidelines, they note, only 25% to 30% of RA patients are immunized against flu or pneumonia, due to lack of awareness among health care professionals and patients' distrust of vaccines.

Both flu and pneumonia vaccines use inactivated viruses and pose no risk of viral reactivation. Studies also show no links between vaccination and worsening RA.

The current meta-analysis of 12 studies finds that patients taking MTX show reduced antibody responses to initial and booster doses of polysaccharide and covalent pneumococcal vaccines, and potentially lesser responses to immunization against the H1N1 and H3N2 influenza A strains and one B strain.

Patients given RTX had lower antibody titers in responses to both immunizations, compared to patients not receiving the infusions.

The analysis was limited by the small number of studies reviewed, the investigators say. However, based on their findings and previous research, they suggest that ideally vaccinations should be given before starting MTX. However, they stress, patients can still have a response after beginning treatment.

Pneumonia vaccine can be given before or after RTX infusions, but flu shots can be delayed 2-3 weeks, depending on disease activity.