Effect of methotrexate, anti-tumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis
Abstract
Objective: To assess the current literature on the impact of rheumatoid arthritis (RA) treatments on the humoral response to pneumococcal and influenza vaccines. Methods: We systematically searched the literature for studies evaluating the immune response to vaccines in RA patients receiving methotrexate (MTX) and/or biologic agents. The efficacy of vaccination, assessed by the response rate based on increased antibody titers before and 3–6 weeks after vaccination, was extracted by one investigator and verified by another. Results: In total, 12 studies were included. RA patients mainly received MTX, anti–tumor necrosis factor α (anti‐TNFα), or rituximab (RTX). Influenza vaccination response was reduced for RTX (43 patients; pooled odds ratio [OR] 0.44 [95% confidence interval (95% CI) 0.17–1.12] for H1N1, OR 0.11 [95% CI 0.04–0.31] for H3N2, and OR 0.29 [95% CI 0.10–0.81] for B) but not for anti‐TNFα (308 patients; OR 0.93 [95% CI 0.36–2.37] for H1N1, OR 0.79 [95% CI 0.34–1.83] for H3N2, and OR 0.79 [95% CI 0.37–1.70] for B). For MTX, results differed depending on the method of analysis (222 patients; OR 0.35 [95% CI 0.18–0.66] for at least 2 strains, ORs were close to 1.0 in the single strain analysis). Pneumococcal vaccination response was reduced for 139 patients receiving MTX compared with controls (OR 0.33 [95% CI 0.20–0.54] for serotype 6B and OR 0.58 [95% CI 0.36–0.94] for 23F) but not for anti‐TNFα (258 patients; OR 0.96 [95% CI 0.57–1.59] for 6B and OR 1.20 [95% CI 0.57–2.54] for 23F). For RTX, the response was reduced (88 patients; OR 0.25 [95% CI 0.11–0.58] for 6B and OR 0.21 [95% CI 0.04–1.05] for 23F). Conclusion: MTX decreases humoral response to pneumococcal vaccination and may impair response to influenza vaccination. The immune response to both vaccines is reduced with RTX but not with anti‐TNFα therapy in RA patients.
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Prior data show anti-CD20 therapy negatively impacts humoral response to various vaccines, though seroprotection can still occur in rituximab- and ocrelizumab-treated patients.
“Our findings are in line with the previously published data regarding the negative impact of anti-CD20 therapy on the humoral response to various vaccines, although seroprotection could be still achieved after vaccination in rituximab-treated 20 26 34-36 and ocrelizumab-treated 37 patients.”
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Impfungen bei Immundefekten/Immunsuppression – Expertenstatement und Empfehlungen
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The Use of COVID-19 Vaccines in Patients with SLE
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Methotrexate and BAFF interaction prevents immunization against TNF inhibitors
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To Be or Not To Be Vaccinated: That Is a Question in Myasthenia Gravis
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Rituximab in the treatment of multiple sclerosis in the Hospital District of Southwest Finland
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The effect of disease-modifying antirheumatic drugs on vaccine immunogenicity in adults
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Current Take on Systemic Sclerosis Patients’ Vaccination Recommendations
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- Authors
- Hua, C., Barnetche, T., Combe, B., & Morel, J.
- Affiliations
- Hôpital Lapeyronie (FR)
- Centre Hospitalier Universitaire de Bordeaux (FR)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2014-06-26
- Volume
- 66
- Issue
- 7
- Pages
- 1016-1026
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- OpenAlex
- W1513110336
- Cited by
- 287
- References
- 32
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 23 · 2023: 23 · 2022: 50 · 2021: 61 · 2020: 28 · 2019: 20 · 2018: 17 · 2017: 14 · 2016: 13 · 2015: 16 · 2014: 4
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Supported by Abbott
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Life Sciences › Immunology and Microbiology › Immunology › Immunotoxicology and immune responses
- Keywords
- rheumatoid arthritis, vaccine response, influenza vaccination, pneumococcal vaccine, methotrexate, anti-TNF therapy, rituximab, humoral immune response, antibody titers, biologic therapy, vaccine efficacy in immunocompromised patients, serotype 6B, serotype 23F, H1N1, H3N2
- MeSH terms
- Rituximab, Humans, Influenza Vaccines, Methotrexate, Tumor Necrosis Factor-alpha, Down-Regulation, Antirheumatic Agents, Pneumococcal Vaccines, Immunity, Humoral, Antibodies, Monoclonal, Murine-Derived
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