Methotrexate users have a reduced immune response to the COVID-19 mRNA vaccine

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A medical assistant prepares a dose of a COVID-19 vaccine to administer to a patient. Credit: Public domain image courtesy of Lisa Ferdinando, U.S. Department of Defense

Up to one-third of patients taking methotrexate, a common treatment for immune-mediated inflammatory conditions such as rheumatoid arthritis and psoriasis / psoriatic arthritis, did not achieve an adequate immune response to COVID mRNA vaccines. -19 in a small study accepted for publication in the journal Annals of rheumatic diseases.

Although COVID-19 mRNA vaccines have been shown to produce an effective effect in more than 90% of in clinical trials, it is unknown whether the immune response is so robust in patients with immune-mediated inflammatory diseases (IMID) that they may also be taking immunomodulatory drugs.

The authors evaluated the immune response to Pfizer-BioNTech COVID-19 mRNA in 82 patients with inflammatory immune diseases (mainly psoriasis / i ) receive methotrexate or an alternative immunomodulator (mainly TNF inhibitors and other biological products) at two centers: New York University Langone Health (New York, USA) and the FAU Erlangen-Nuremberg and Universitatsklinikum Erlangen (Erlangen, Germany).

The study found that the Pfizer-BioNTech vaccine induced adequate antibody levels in one-third fewer patients with methotrexate, compared with healthy participants and patients with IMID from the other immunomodulatory drugs.

Adequate antibody levels occurred in more than 90% of the 208 healthy participants and 37 patients in biological or non-methotrexate oral treatments, but only in 62% of the 45 patients taking methotrexate.

Furthermore, while vaccination induced activated CD8 + T cell responses in healthy participants and patients with immunity-mediated inflammatory diseases who did not take methotrexate, this same induction was not seen in those patients with methotrexate. T cells are another part of the body’s immune defense system.

It is an observational study and, as such, cannot establish causality. The authors also acknowledge that the study had one , evaluated only one type of COVID-19 mRNA vaccine, and may have included patients with previously asymptomatic COVID-19 infections.

They also note that patients with methotrexate IMID were generally larger than the comparison group (mean age 63 to 49 years), which may explain some differences in immunogenicity.

In addition, the authors note that “it is not yet clear what level of immunogenicity is representative of the efficacy of the vaccine.”

They go on to point out that “although precise limits of immunogenicity that correlate with vaccine efficacy have not yet been established, our findings suggest that different strategies may need to be explored in patients with immunity. take methotrexate to increase the chances of efficacy of immunization against SARS-CoV-2, as has been shown to increase immunogenicity to other viral vaccines. “

For example, methotrexate has been shown to reduce the immune response to the flu vaccine.

The authors add: “Our results suggest that optimal protection of patients with IMID against COVID-19 will require additional studies to determine whether additional doses of vaccine, dose modification of methotrexate, or even temporary discontinuation of this drug may increase. the immune response has been demonstrated for other viral vaccines in this patient population “.


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More information:
Methotrexate removes immunogenicity in the BNT162b2 COVID-19 mRNA vaccine in immunity-mediated inflammatory diseases, Annals of rheumatic diseases (2021). DOI: 10.1136 / annrheumdis-2021-220597

Citation: Methotrexate Users Have Reduced Immune Response to COVID-19 mRNA Vaccine (2021, May 25) Retrieved May 25, 2021 at https://medicalxpress.com/news/2021-05-methotrexate-users- immune-response-mrna.html

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