Daijiworld Media Network - New Delhi
New Delhi, May 25: Delaying the start of Methotrexate for one month after receiving the 13-valent pneumococcal conjugate vaccine was not found to worsen disease control or structural progression in patients with Rheumatoid Arthritis, according to an ancillary analysis of the VACIMRA trial.
The original VACIMRA trial had earlier shown that postponing methotrexate initiation for one month after receiving the 13-valent pneumococcal conjugate vaccine improved humoral vaccine responses at both one month and 12 months.
The follow-up analysis examined whether delaying methotrexate treatment could negatively affect the early treatment window for rheumatoid arthritis patients.
Researchers compared patients with early rheumatoid arthritis who started methotrexate immediately after vaccination with those who began treatment one month later.
Investigators assessed changes in disease activity using DAS28-ESR scores at Months 1, 2, 3, 6 and 12. Radiographic progression was measured using the van der Heijde modified Sharp score based on X-rays taken at inclusion, Month 6 and Month 12.
Among the 276 participants enrolled in the VACIMRA trial, 100 were from the Montpellier centre. Of these, 96 patients were analysed at baseline and 83 completed the 12-month follow-up.
Researchers said baseline characteristics in both groups were similar, including an average age of 58 years, a baseline DAS28-ESR score of 4.88 and a modified Sharp score of 1.53.
At 12 months, remission rates were found to be comparable between the two groups, with 53.7 per cent remission in the immediate-treatment group and 46.3 per cent in the delayed-treatment group.
Similarly, rates of low disease activity were not significantly different, recorded at 75.6 per cent and 61 per cent respectively.
DAS28-ESR scores remained similar during Months 1 and 3, while outcomes slightly favoured the delayed-treatment group at Months 6 and 12.
The study also found no significant difference in radiographic progression between the two groups at Month 6 and Month 12, indicating that delaying methotrexate for one month after vaccination did not lead to increased joint damage during the first year.
Researchers said the findings suggest that vaccination schedules and rheumatoid arthritis treatment could be aligned more effectively in selected patients.
The authors concluded that deferring methotrexate initiation for one month after PCV13 vaccination may help improve immunity without compromising rheumatoid arthritis disease control or increasing the need for treatment escalation over one year.