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

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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

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