Rheumatoid arthritis patient trial backs up vaccination advantages of methotrexate delay

Delaying methotrexate treatment for a month after pneumococcal conjugate vaccination does not worsen outcomes for people with early rheumatoid arthritis (RA), according to new research.

The finding comes from a follow-up analysis of the VACIMRA trial, which had shown that postponing methotrexate for one month after receiving the 13-valent pneumococcal conjugate vaccine (PCV13) improved antibody responses at one and 12 months.

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Researchers wanted to determine whether the short delay would compromise the early treatment window in patients with RA.

The analysis found no evidence that postponing methotrexate affected disease control during the first year of treatment.

Remission rates after 12 months were shown to be similar in patients who started treatment immediately and those who waited a month following vaccination.

There was also no indication that the delay led to a higher level of joint damage, as X-rays taken at six and 12 months showed similar levels of radiographic progression in both groups.

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In addition, the treatment delay did not increase the need to escalate treatment over the first year.

Disease activity scores were similar between the groups during the early stages of treatment, and by six and 12 months they were favourable to those whose methotrexate treatment had been delayed.

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The researchers concluded that deferring methotrexate treatment for one month after PCV13 vaccination could be a viable strategy for enhancing immunity without undermining outcomes for patients with early RA.

A version of this article was first published by our sister title The Pharmacist