Methotrexate Treatment may jeopardize immune responses of COVID-19 vaccination in Rheumatoid Arthritis Patients: Study

• 7 days after vaccination with two injections of the SARS-CoV-2 vaccines, MTX-treated patients had equivalent overall B and T cells count compared to controls.

• The frequencies of spike-specific B cells were unchanged by MTX treatment. More remarkably, MTX treatment reduced antigen-specific CD4 T cells to a very minimal level, which was well correlated with the levels of anti-RBD IgG antibodies.

• Patients in the MTX-treated group had inductions that were significantly lower than those of patients not treated with MTX, with a median of 0.17 (95% CI, 0.12 to 0.21) in comparison to 0.29 (95% CI, 0.18 to 0.39) for those not on MTX (P = 0.017).

• Antibody response was associated with very low antibody responses, as the level of induction of CD4 T cells could be inversely correlated with antibody responses, indicating that perhaps the treatment with MTX may delay the vaccination-induced immune response in RA patients.

• While the CD4 T cell activity was lower in the patients treated with MTX, the frequencies of spike-specific B cells were similar between these patients and controls.

The study concludes that MTX decreases specific CD4 T cell responses in patients with RA, an effect seemingly leading to kinetics of antibodies significantly decelerated. The clinical relevance of it all, as a whole, has yet to be shown however, the immune responses in such patients on MTX therapy would be vital toward being monitored as vaccination efforts proceed.

Reference:

Kummer LYL, Fernández Blanco L, Kreher C On behalf of the T2B! Immunity Against SARS-CoV-2 Study Group, et al. Methotrexate treatment hampers induction of vaccine-specific CD4 T cell responses in patients with IMID. RMD Open 2024;10:e004664. doi: 10.1136/rmdopen-2024-004664