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Flu shot stop mtx for two weeks study -stopping improves flu shot results

my little penguin

Staff member
SAN DIEGO — For people with rheumatoid arthritis, immune response to the flu vaccine is significantly stronger when methotrexate therapy is discontinued for 2 weeks after immunization, results from a prospective multicenter randomized trial show. But this temporary cessation has no effect on rheumatoid arthritis disease activity.
The response was better by 15% to 20%, as expected, but there was no increase in the flare rate," said investigator Jin Kyun Park, MD, from Seoul National University Hospital in South Korea.

"I hope this study will mean that fewer physicians will be scared of giving the vaccine. We know we should give vaccines, but we don't always do that in the clinic," he said here at the American College of Rheumatology 2017 Annual Meeting.
The trial builds on a pilot study in which Dr Park and his colleagues assessed patients who temporarily stopped methotrexate for 4 weeks before vaccination, 2 weeks before and 2 weeks after vaccination, and 4 weeks after vaccination, or who continued methotrexate (Ann Rheum Dis. 2017;76:1559-1565). The results demonstrated that suspending methotrexate for 2 weeks after vaccination is the best way to increase the effectiveness of the flu vaccine with no increase in the risk for disease flares.
Improving Vaccine Effectiveness

When the vaccine is administered, "we ask patients to skip the next 2 weekly doses," Dr Park explained. People might be less compliant if they are asked to hold off on 2 weekly doses before coming to the clinic.
Because patients taking methotrexate could be at a higher risk for infection, preventive measures like flu vaccination are particularly important, he pointed out.
In the intent-to-treat analysis, 156 were randomized to continue their methotrexate and 160 people took a 2-week drug holiday after their flu shot.
All participants received the seasonal quadrivalent influenza vaccine, which contained H1N1, H3N2, B/Yamagata, and B/Victoria, from October 7, 2016 to January 9, 2017.
More patients who temporarily stopped methotrexate than continued achieved seroprotection related to each strain in the vaccine.


my little penguin

Staff member
We never stopped mtx for the flu shot in 7-8 years
We were told to try to get it in the middle as possible time wise of biologics though .
Which is tricky with two of them
Mainly I focus on 14 days from last Stelara shot since it’s half way
Ugh. Flu shots today. MTX for one and Humira for the other tonight. And MTX kid gets weekly Humira Monday. No way to space without skipping a dose.

I'll just have to make my best call.

my little penguin

Staff member
Fwiw Ds gets one biologic every other week and Stelara every 28 days plus mtx once a week .
So timing is never good .
When he was on humira every week plus mtx once a week and second different biologic daily - yep still got the flu shot and hoped for the best
It’s all you can do .

we never held maintenance meds for the flu shot


Staff member
I think the studies were primarily done on RA patients, if I'm remembering correctly.

We have never skipped MTX for the flu shot. In the last 11-12 years, both girls have had the shot while on MTX or Imuran or Arava (similar arthritis med). No issues so far (neither, thankfully, has had the flu) - sometimes they have even been given it in the hospital when they went in for infusions!