In a nutshell
This study looked at the effect of rheumatoid arthritis (RA) treatments on patient reponses to influenza and pneumococcal vaccinations. The treatments included in this study were methotrexate (Rheumatrex), rituximab (Rituxan) and anti-tumor necrosis factor alpha (TNFa) drugs. Methotrexate and rituximab decreased patient responses to both vaccines.
Some background
In RA, the immune system attacks the healthy joints the way it would a virus or bacteria. Treatments for RA are designed to stop the immune system from attacking healthy joints. Some common treatments for RA are methotrexate, rituximab and anti-TNFa drugs (such as adalimumab or etanercept). Methotrexate is a synthetic drug that can reduce inflammation. Rituximab is a biological drug that can attack and kill the cells that are known to increase disease activity in RA. TNFa is a protein that contributes to the over-activation of the immune system. Anti-TNFa drugs block the activity of TNFa.
RA patients that receive these treatments have a weakened immune system and an increased risk of infection and so vaccines are highly recommended. In particular, vaccines against pneumococcus bacteria (which can cause pneumonia and other serious infections) and influenza (the "flu") should be considered.
Methods & findings
A total of 12 studies, including 1,303 patients, were investigated by the authors. They looked at effect of methotrexate, rituximab and anti-TNFa drugs on patient responses to vaccinations. The vaccines included in the study were against influenza and pneumococcus bacteria.
Rituximab reduced the immune response in RA patients to the influenza vaccine by up to 89% and to the pneumococcal vaccine by up to 79%. Methotrexate reduced the RA patient immune response to the influenza vaccine by up to 65% and to the pneumococcal vaccine by up to 67%. Anti-TNFa drugs showed no negative effect on patient responses to either of the vaccinations.
The bottom line
The authors concluded that methotrexate and rituximab decreased RA patient response to influenza and pneumococcal vaccines. Anti-TNFa drugs had no effect on RA patient responses to either vaccine.
The fine print
These findings are based on results that were calculated by combining different studies. The studies were all carried out separately and there may be significant differences in the methods used and the patients included in each study.
What’s next?
Consult with your physician regarding the risks and benefits of receiving vaccinations during treatment for RA.
Published By :
Arthritis Care & Research
Date :
Jul 01, 2014
