Pausing immune-supressing treatment can improve the efficiency of the COVID-19 booster


A collaborative study by the NIHR Imperial, Nottingham and Oxford Biomedical Research Centres, has found that pausing immune-suppressing treatment in patients with immune-mediated inflammatory diseases can boost the efficiency of the COVID-19 vaccine booster.
Patients taking immune-suppressants are at high risk to COVID-19 and were advised to shield throughout the peak of the pandemic and so it is a key challenge to optimise their responses following vaccination. The efficiency of vaccine-induced immunity is impaired in patients taking immunosuppressant’s such as methotrexate due to its broad-natured immunosuppressing effects. Previous data has shown that pausing immune-suppressing treatment following influenza vaccination increased vaccine immunity and so this trail aimed to assess if the same effect would be seen following Covid-19 Booster vaccination.
In this study 254 patients were recruited who are receiving treatment for inflammatory conditions including rheumatoid arthritis or psoriasis. All were to have been on methotrexate for at least 3 months and have previously received their first 2 doses of a COVID-19 vaccine. The patients were divided into two arms, to either continue with their methotrexate treatment or pause the treatment for 2 weeks after receiving their booster vaccine.
Antibody levels were evaluated at 4- and 12-weeks post-vaccination as this is a key indicator of the efficiency of the vaccine-induced immune response in the patient. The findings from the study showed a 2-fold increase in antibodies after 4 weeks in the patients who paused taking methotrexate and this elevation was maintained until 12-weeks post-vaccination.
There was no significant difference in general quality of life between the two arms of the study. However there was temporary deterioration in self-reported diseases activity and disease control at 4weeks in the paused methotrexate patients compared to the control, but this was resolved by 12 weeks. Patients in the paused methotrexate group reported an increase in flare ups in the first 4 weeks but were able to manage them without needing to seek additional medical input.
These findings indicate that for patients who are able to pause their treatment for 2 weeks immediately after vaccination for COVID-19 will have improved vaccine-induced immunity.