Delaying methotrexate treatment by one month following pneumococcal vaccination significantly enhances the humoral immune response in patients with rheumatoid arthritis (RA), according to findings presented at ACR Convergence 2024.
“Vaccination against pneumococcus is essential for RA patients receiving methotrexate therapy,” explained Jacques Morel, MD, from the University Hospital of Montpellier in France. “Our study aimed to compare the effectiveness of the PCV13 vaccine when administered either one month before starting methotrexate or concurrently with methotrexate initiation.”
Morel shared these findings during his presentation at ACR Convergence 2024, emphasizing that this is the first study to demonstrate the benefit of administering PCV13 one month prior to methotrexate initiation without adversely affecting RA disease activity.
To investigate optimal vaccine timing, Morel and colleagues enrolled 276 RA patients, all of whom received the PCV13 vaccine at the start of the study, followed by the PPV23 vaccine two months later. After PCV13 administration, participants were randomly assigned to either begin methotrexate immediately or delay treatment for one month. Vaccine efficacy was measured by the rate of at least a two-fold increase in IgG antibodies, determined using enzyme-linked immunosorbent assay (ELISA) and opsonic pneumococcal antibody (OPA) testing. Additionally, researchers assessed PCV13 response based on positive antibody responses to at least three of the five targeted serotypes.
The study cohort was predominantly female (70%), with a mean age of 55.6 years and an average RA duration of two months. Anti-citrullinated protein antibodies (ACPA) were present in 69% of participants.
Key results indicated that, as assessed by ELISA, 88% of patients in the delayed methotrexate group achieved a vaccine response, compared to 75% in the immediate methotrexate group (P < .01). Similar trends were observed in OPA responses, with 96% of the delay group achieving higher response rates compared to 88% in the immediate group (P = .02). Furthermore, the delayed initiation group showed superior antibody responses for the five targeted serotypes.
“These findings clearly show that administering PCV13 one month before methotrexate initiation leads to significantly improved immunological responses compared to simultaneous administration,” Morel concluded. “This approach has no detrimental effect on RA disease activity.”
Source:
Morel J. Abstract #2676. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
Disclosures:
Morel reports no relevant financial conflicts.
