Aktualisierte Handlungsempfehlungen der Deutschen Gesellschaft für Rheumatologie für die Betreuung von Patienten mit entzündlich-rheumatischen Erkrankungen im Rahmen der SARS-CoV‑2/COVID‑19-Pandemie einschließlich Empfehlungen zur COVID‑19-Impfung

Specker, Christof; Aries, Peer; Braun, Jürgen; Burmester, Gerd R; Fischer‐Betz, Rebecca; Hasseli, Rebecca; Holle, Julia; Hoyer, Bimba F.; Iking‐Konert, Christof; Krause, Andreas; Krüger, Klaus; Krusche, Martin; Leipe, Jan; Lorenz, Hanns‐Martin; Moosig, Frank; Schmale-Grede, Rotraud; Schneider, Matthias; Strangfeld, Anja; Voll, Reinhard; Voormann, Anna; Wagner, Ulf; Schulze‐Koops, Hendrik

doi:10.1007/s00393-021-01056-6

Cited by 10 publications

(35 citation statements)

References 92 publications

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“…16 Therefore, our main objective was to study the effect of MTX and its discontinuation on the humoral immune response after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD). Secondary objective 15 Additionally, patients with AIRD who were vaccinated under no immunosuppressive therapy served as controls. Information regarding medical history including COVID-19 vaccination status and immunosuppressive therapy were provided directly by patients and additionally validated with medical records.…”

Section: Miscellaneousmentioning

confidence: 99%

“…However, data regarding MTX-hold during COVID-19 vaccination are still lacking, which is why current guidelines are based on experience with influenza vaccines, not considering mRNA-based technology used for COVID-19 vaccinations. Although current guidelines by the American College of Rheumatology as well as the German Society for Rheumatology recommend holding MTX 1–2 weeks after COVID-19 vaccination,14 15 the European League Against Rheumatism does not recommend pausing MTX 16…”

Section: Introductionmentioning

confidence: 99%

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Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases

et al. 2022

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ObjectiveTo study the effect of methotrexate (MTX) and its discontinuation on the humoral immune response after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD).MethodsIn this retrospective study, neutralising SARS-CoV-2 antibodies were measured after second vaccination in 64 patients with AIRD on MTX therapy, 31 of whom temporarily paused medication without a fixed regimen. The control group consisted of 21 patients with AIRD without immunosuppressive medication.ResultsPatients on MTX showed a significantly lower mean antibody response compared with patients with AIRD without immunosuppressive therapy (71.8% vs 92.4%, p<0.001). For patients taking MTX, age correlated negatively with immune response (r=−0.49; p<0.001). All nine patients with antibody levels below the cut-off were older than 60 years. Patients who held MTX during at least one vaccination showed significantly higher mean neutralising antibody levels after second vaccination, compared with patients who continued MTX therapy during both vaccinations (83.1% vs 61.2%, p=0.001). This effect was particularly pronounced in patients older than 60 years (80.8% vs 51.9%, p=0.001). The impact of the time period after vaccination was greater than of the time before vaccination with the critical cut-off being 10 days.ConclusionMTX reduces the immunogenicity of SARS-CoV-2 vaccination in an age-dependent manner. Our data further suggest that holding MTX for at least 10 days after vaccination significantly improves the antibody response in patients over 60 years of age.

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Section: Miscellaneousmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases

et al. 2022

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“…Participants were recruited between April and September 2021 and had to meet the following inclusion criteria: age 18 years or older, AIRD diagnosis and vaccination with a COVID-19 vaccine authorised for use in Germany. For this analysis, only AIRD patients under MTX therapy were considered, receiving either only MTX or MTX combined with low dose prednisolone (defined as ≤ 5 mg/d), TNFα-Inhibitors, hydroxychloroquine, leflunomide, IL-17 or IL-12/23 inhibitors, since these immunosuppressive comedications are not known to have a remarkable impact on the immune response after vaccination 16 . Additionally, AIRD patients who were vaccinated under no immunosuppressive therapy served as controls.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…However, data regarding MTX-hold during COVID-19 vaccination are still lacking, which is why current guidelines are based on experience with influenza vaccines, not considering mRNA based technology used for COVID-19 vaccinations. Although current guidelines by the American College of Rheumatology as well as the German Society for Rheumatology recommend holding MTX one to two weeks after COVID-19 vaccination 14 15 , the EULAR does not recommend pausing MTX 16 .…”

Section: Introductionmentioning

confidence: 99%

Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases

Silva

Frommert

Albach

et al. 2021

Preprint

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ObjectiveTo study the effect of methotrexate (MTX) and its discontinuation on the humoral immune response after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD).MethodsNeutralising SARS-CoV-2 antibodies were measured after second vaccination in 64 rheumatic patients on methotrexate therapy, 31 of whom temporarily paused medication without a fixed regimen. The control group consisted of 21 AIRD patients without immunosuppressive medication.ResultsMTX patients showed a significantly lower median antibody response compared to AIRD patients without immunosuppressive therapy (p< 0.001). Young age (<60 years) and MTX-hold after vaccination were found to be the main factors influencing antibody response after vaccination, while BMI or MTX dose demonstrated no effect. For patients taking MTX, age correlated negatively with immune response (r=-0.49; p<0.001) and all patients with antibody levels (14 %) below the cut-off were older than 60 years. Patients who held MTX during at least one vaccination showed significantly higher median neutralising antibody levels after second vaccination, compared to patients who continued MTX therapy during both vaccinations (68.82 %, 92.73 %, p=<0.001). This effect was particularly pronounced in patients older than 60 years (p=0.0016). The impact of the time period after vaccination was greater than of the time before vaccination with the critical cut-off being 10 days.ConclusionMTX reduces the immunogenicity of SARS-CoV-2 vaccination in an age-dependent manner. Our data further suggest that holding MTX for at least 10 days after vaccination significantly improves the antibody response in patients over 60 years of age.

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“…Die Empfehlungen der DGRh wurden und werden den neuesten Erkenntnissen entsprechend laufend angepasst [ 6 ]. Darüber hinaus wurden europäische Handlungsempfehlungen erstellt [ 7 ], wobei sich diese nicht relevant von den Empfehlungen der DGRh unterscheiden.…”

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COVID-19 in der rheumatologischen Routineversorgung

Sg¹,

Länger²,

Châtelain

2021

rheuma plus

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Aktualisierte Handlungsempfehlungen der Deutschen Gesellschaft für Rheumatologie für die Betreuung von Patienten mit entzündlich-rheumatischen Erkrankungen im Rahmen der SARS-CoV‑2/COVID‑19-Pandemie einschließlich Empfehlungen zur COVID‑19-Impfung

Abstract: enthält die Patientenversion der Handlungsempfehlung und Informationen zur passiven Immunisierung mit neutralisierenden Antikörpern. Alle Autoren schreiben im Auftrag des Vorstandes der Deutschen Gesellschaft für Rheumatologie Die englische Version dieser Handlungsempfehlung ist unter

Cited by 10 publications

References 92 publications

Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases

Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases

Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases

COVID-19 in der rheumatologischen Routineversorgung

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