Methotrexate Lowers Response to Pneumococcal Vaccine

In patients with arthritis, methotrexate reduces antibody response after pneumococcal vaccination

MONDAY, Aug. 22 (HealthDay News) -- In patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA), treatment with methotrexate (MTX), but not with tumor necrosis factor (TNF) blockers, reduces antibody response after vaccination with pneumococcal conjugate vaccine, according to a study published online Aug. 10 in Arthritis & Rheumatism.

Meliha C. Kapetanovic, M.D., Ph.D., from Lund University in Sweden, and colleagues investigated the influence of anti-inflammatory treatment (MTX or TNF blockers) on antibody response following vaccination with one intramuscular dose of 7-valent conjugate pneumococcal vaccine (Prevenar; marketed as Prevnar in the United States) in 505 patients with RA or SpA, including psoriatic arthritis. Participants were divided into six groups based on diagnosis and treatment: RA patients on MTX; RA on anti-TNF and MTX; RA on monotherapy TNF blockers; SpA patients on anti-TNF drugs and MTX; SpA on anti-TNF monotherapy; and SpA on non-steroidal anti-inflammatory drugs and/or analgesics (control group). The immunoglobulin-G antibody levels against 23F and 6B serotypes were measured at vaccination and four to six weeks later. Ratio of post-/pre-vaccination antibody levels or antibody response ratio (ARR) was measured, and ARR greater than or equal to two was defined as a positive antibody response (posAR).

The investigators identified significant differences in ARR between the groups. Compared to groups treated with MTX or MTX and TNF-blockers, ARR was better in controls. Compared to controls, lower but not significantly different ARR was observed for both serotypes in patients on TNF-blockers as monotherapy. Higher age was correlated with impaired posAR. Continuing MTX treatment predicted lower posAR response, and concomitant prednisolone in patients with RA resulted in better posAR.

"MTX but not anti-TNF treatment in patients with RA and SpA reduces antibody response after vaccination with pneumococcal conjugate vaccine," the authors write.

Prevenar vaccines for this study were provided by Wyeth Pharmaceuticals.

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