HCP Live
Contagion LiveCGT LiveNeurology LiveHCP LiveOncology LiveContemporary PediatricsContemporary OBGYNEndocrinology NetworkPractical CardiologyRheumatology Netowrk

Certain DMARDs Reduce Vaccine Efficacy in Patients With RA

“These data suggest that vaccine responses are reduced but can be improved by sufficient vaccine/virus exposure,” investigators stated.

Patients with rheumatoid arthritis (RA) on disease-modifying antirheumatic drugs (DMARDs) appeared to have a reduced response rates to the SARS-CoV-2 vaccination, according to a study published in RMD Open.1 While responses improved with second and third doses, approximately 10% of patients remained seronegative.

“These data suggest that vaccine responses are reduced but can be improved by sufficient vaccine/virus exposure,” investigators stated. “The data support the use of a third dose of the vaccination with cessation of specific drugs to optimize response.”

A total of 107 patients with RA on various DMARDs, along with 9 healthy controls, were assessed for antibody and T cell analysis both pre-vaccination and 4 weeks post-vaccination. A positive antibody response was defined as sera IgG binding to ≥1 antigen. Those who continued to be seronegative after the first dose of the vaccine were tested 4 weeks after the second dose. If they remained seronegative, they were retested after a third dose. T cell response was determined by a T-Spot-Covid ELISpot count of ≥7 interferon (IFN)γ-positive cells when exposed to spike antigens.

Roughly half (45%) of patients (n = 37/83) had a vaccine-specific antibody response after the first dose of the vaccine, 53% (n = 44/83) had vaccine specific T cell responses, and 77% (n = 64/83) had either antibody or T cell responses.

Patients receiving abatacept (0%; n = 0/11), rituximab (RTX) (35%; n = 10/29), and concomitant methotrexate (MTX) (p=0.01, OR: 8, 95% CI: 1.63 to 37.98) were more likely to experience reduced seroconversion when compared with controls.

Those receiving anti-tumor necrosis factor (TNF) drugs had better seroconversion when compared with those receiving RTX (p=0.012, OR: 12, 95% CI: 1.71 to 85.24). Seroconversion was seen in 65% (n = 17/26) of patients taking anti-TNF, 56% (n =5/9) taking Janus Kinase inhibitors (JAKi), and 63% (n = 5/8) of those taking anti-interleukin 6 (IL-6). However, antibody responses were found in 100% of the health controls.

Patients who were exposed to COVID-19 prior to their vaccination were 17 times more likely to develop seroconversion (≥3 antibodies) (p<0.001).

For those in the non-seroconverters group, a second dose of the vaccine produced seroconversion in 54% (n = 19/35) and a third dose produced it in 20% of the 10 remaining patients.

An age of ≤50 years (p=0.012, OR: 18, 95% CI: 1.87 to 179.09) was also associated with seroconversion after the first vaccine dose.

The requirement for baseline samples limited the study as investigators were only able to recruit a small number of patients, particularly in the control group. However, the 100% seroconversion rate validates the analysis.

“These data confirm reduced immune responses to SARS-CoV-2 vaccine in patients with RA particularly on certain DMARDs,” investigators concluded. “The impact of a booster dose in patients with absent antibody responses to a 3 dose vaccination schedule will need to be determined.”


Saleem B, Ross RL, Bissell LA, et al. Effectiveness of SARS-CoV-2 vaccination in patients with rheumatoid arthritis (RA) on DMARDs: as determined by antibody and T cell responses. RMD Open. 2022;8(1):e002050. doi:10.1136/rmdopen-2021-002050