June 27, 2022

expert reaction to study looking at interrupting the treatment of the immune-suppressing medicine methotrexate and antibody response to COVID-19 booster vaccination

A study published in the Lancet Respiratory Medicine looks at the effect of a 2-week interruption in methotrexate treatment on COVID-19 booster vaccine immunity in adults with inflammatory conditions.

This Roundup accompanied an SMC Briefing.

Prof Neil Mabbott, Personal Chair in Immunopathology, University of Edinburgh, said:

“This is an interesting and important study that describes a simple and cheap method to help improve COVID-19 vaccine responses of some immune-mediated inflammatory disease patients on long-term immunosuppressive drugs such as methotrexate.  The study showed that a two week interruption to the patients methotrexate treatment was sufficient to increase their antibody responses to COVID-19 by approximately 2 fold.  Importantly their antibody levels were maintained 12 weeks after the brief period of treatment suspension.

“There are still some questions to be addressed.  For example, further research is now required to determine whether the increase in antibody levels after vaccination in those who underwent treatment suspension also have an increased level of protection against infection with the coronavirus and a reduced incidence of serious COVID-19 and hospitalisation.  It will also be interesting whether a temporary treatment suspension approach is similarly effective when used in combination with other vaccinations such as the annual flu shot, and whether it can be applied to patients undergoing long-term treatment with other immunosuppressant drugs.

“However, more of the patients in the treatment suspension group reported at least one flare-up in their disease symptoms compared to those who didn’t interrupt their treatment.  Thus, the use of short-term interruptions to immunosuppressive treatments in this manner should be used with caution and only after careful risk assessment by the patient’s clinicians.  This type of treatment should only be taken under medical advice and may in some circumstances be too risky for some patients with serious conditions, or in those with complex diseases.”

‘Effect of a 2-week interruption in methotrexate treatment versus continued treatment on COVID-19 booster vaccine immunity in adults with inflammatory conditions (VROOM study): a randomised, open label, superiority trial’ by Abhishek Abhishek et al. was published in the Lancet Respiratory Medicine at 23:30 UK time on Monday 27 June 2022.

DOI: 10.1016/S2213-2600

Declared interests

Prof Neil Mabbott: “I have no conflicts of interest to declare.”