REVIEW - Immunization of patients with RA with anti-TNF therapy and MTX

[Guest guest]

Curr Opin Rheumatol. 2008 May;20(3):295-9.

Immunization of patients with rheumatoid arthritis with antitumor

necrosis factor alpha therapy and methotrexate.

Brezinschek HP, Hofstaetter T, Leeb BF, Haindl P, Graninger WB.

Division of Rheumatology, Department of Internal Medicine, Medical

University Graz, Graz, Austria.

PURPOSE OF REVIEW: The aim of this study is to highlight the recent

findings on the use of methotrexate and/or TNFalpha-blockers in adult

patients with rheumatoid arthritis and their effects on the immune

response to various vaccines. RECENT FINDINGS: Regarding influenza

vaccination, methotrexate monotherapy is not associated with a

decreased response, whereas the use of etanercept and infliximab in

combination with methotrexate may cause lower titers and lower

response rates. Concerning pneumococcal vaccination, methotrexate

seems to impair responsiveness. The concomitant use of adalimumab and

methotrexate is also associated with decreased response, whereas the

concomitant use of etanercept or infliximab seems not to have an

effect on response rates. As immunological pathways seem to play a

major role, T-cell-dependent pneumococcal vaccines are designed to

achieve higher response rates and protective titers. SUMMARY: Patients

with rheumatic disorders are more likely to develop preventable

infectious diseases, which underlines the importance of adequate

immunoprotective titers. Several studies have shown that the

combination of methotrexate and certain TNFalpha-blockers are

affecting the responsiveness to vaccines. Further findings indicate

that the response also depends on what type of vaccine is used.

PMID: 18388521

http://www.ncbi.nlm.nih.gov/pubmed/18388521

Not an MD