Key clinical point: A 2-week methotrexate withdrawal after each dose of Sinovac-CoronaVac vaccine may improve anti-SARS-CoV-2 immunogenicity in patients with rheumatoid arthritis (RA) with low disease activity (LDA) or remission. However, this may increase flare rates, thereby requiring close surveillance of disease activity.
Major finding: At 6 weeks after the second vaccine dose, patients who withheld vs. maintained methotrexate after both vaccine shots had a significantly higher seroconversion ( P = .019) with a parallel increase in geometric mean titer ( P = .006). However, the flare rate (Clinical Disease Activity Index >10) was higher in the group that withheld vs. continued methotrexate ( P = .011).
Study details: Findings are from the single-center, prospective CoronavRheum study that included 138 patients with RA with LDA/remission at first vaccine dose who were randomly assigned to maintain (n = 69) methotrexate use or institute a 2-week withdrawal (n = 60) of methotrexate after each dose of Sinovac-CoronaVac vaccine.
Disclosures: This study was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and B3 - Bolsa de Valores do Brasil. No conflicts of interest were declared.
Source: Renner Araujo CS et al. Two-week methotrexate discontinuation in patients with rheumatoid arthritis vaccinated with inactivated SARS-CoV-2 vaccine: A randomised clinical trial. Ann Rheum Dis. 2022 (Feb 22). Doi: 10.1136/annrheumdis-2021-221916