Methatrexate impairs covid Vax response

[trace58]

I have come across a medical article on results in from a trial on medpagetoday.com saying a one third of patients with immune_mediated inflammatory desease being treated with Methatrexate showed attenuated responses, in two independent cohorts robust antibodies were observed in 98.1% of healthy 91.9% of patients with immune medication not on Methatrexate but only 62.2% of patients on Methatrexate reported Jose U Scher M D of NY U Langone health in New York I have been worried about being on Methatrexate when having the vaccine this makes me anxious and why is everyone in the U K telling me I will have enough protection well they do not know this I would be very carefull people , !!!

[Neonkittie17]

Hi Trace, I think from what I’ve read on websites like BMJ and The Lancet that Mtx has a better chance of not blunting the vaccine’s efficacy than a couple of the other biologics, including mine. I did read many patients were told to hold off Mtx for two weeks after their vaccines, but lots had been given theirs already without this advice so it is difficult. It’s worrying me even though I waited six months after my RA infusion to have the vaccines to try build back immunity. I don’t think my percentage would be anywhere near even 50 per cent. I think until the results of more analysis on larger numbers of immuno-suppressed patients such as the Octave study is known we won’t know for sure.

I have just done one reputable Roche spike protein quantitative antibody test which was void due to me not being able to obtain enough sample to send the lab and the lab/company are going to send me another kit foc. They told me no antibodies could mean I’ve had them earlier and they have since gone as it’s two months now since my second Pfizer. (I think also you need to look at T cells and I’m not sure you’re allowed to ask for those doing as any part of vaccine efficacy testing. You’d need a more in depth analysis of your immune. I’m also going to consult an immunologist as part of investigating my low IgG/IgM on my RA med (and not primarily about vaccine efficacy) but worth an ask and that should be in around a month when I speak to someone. I will ask then re the antibodies and RA meds/biologic immunosuppressants.

I do think all patients on the high spec/RA biologics and meds known/thought to possibly blunt the vaccines’ efficacy should be given a quantitative spike protein antibodies test, but it’s a whole load more testing and work. Maybe for the boosters or in time that could be part of it. I’m told by the Roche testing lab you can still be protected by the vaccine even if your antibodies are low. The level of uncertainty isn’t nice though. We won’t see the results of research until September at least. x

[GinnyE in reply to Neonkittie17]

I've just sent off the antibody test to Lloyd's chemist. What a carry on. Poor little sore fingers. Blood everywhere but in the tube! Did it in the end I think. I'm on methotrexate and all this uncertainty is getting to me. People say to continue to be careful but, on the other hand, some say to get on with life. So, I've eaten out inside restaurants on holiday, and I haven't wiped down my groceries for the first time since this all began. I'm going to see my sister this week. If it was still raining (like it did all through my holiday) I was going to go inside her house. (But she told me last week her friend's son and his child had got the virus, and she sees her friend, although she had tested negative... pause for indecision...

[Neonkittie17 in reply to GinnyE]

I’m on Rituximab and it’s difficult re not having decent immunity when your B cells jigger off for months as Rtx depletes them for 6-9 months before they return so I’m limited what I can do at the mo but I’m ready to change med. I have side effects too so makes it harder. If I was not on my med and didn’t have lowered IgG/IgM I’d do a lot more.

The Roche test is the same I believe as the one Lloyds use. It took three lancets and separate fingers and still I didn’t send them enough. My blood doesn’t seem to want to keep flowing from my finger tips after a few seconds. Will try again next week. 😑

[GinnyE in reply to Neonkittie17]

It's a shame about your meds interfering with efficacy, more than a shame, what a hand this virus has dealt out. I used three lancets too and started getting very cross (and sore). Bet mine comes back as insufficient too.

[Neonkittie17 in reply to GinnyE]

I know, it’s a real pain all the meds and worries -‘ about them interfering with the vaccines and trying to do the right thing. I’m wondering if we can get blood from other than the side of the fingers? The pad of the fingers would seem more plump and appropriate! Hope you did enough for your test and if you do need to repeat they will offer it foc. 🙏🏻 Perhaps they will send us double the lancets and we will be like Swiss cheeses, full of holes! 🤨

[GinnyE in reply to Neonkittie17]

😄

[Knip in reply to Neonkittie17]

I'm wondering if your surgery might help out by getting one of the nurses or the phlebotomist to extract some blood for you during your regular blood check. It wouldn't take them a minute. Very frustrating.

[Neonkittie17 in reply to Knip]

Thank you. I thought of that too but as I’m not due another blood test for a month I don’t think they’d be allowed to do it as a separate appointment/procedure as the receptionist asks which blood tests you are coming for etc. If I can’t get the second home test to work I may ask my GP/rheumy if they can suggest anything. However, If there is no test available as standard at the moment then the hospital can’t analyse/process it. I am supposed to be speaking to an immunologist re my meds and side effects but that won’t be for a while given I won’t speak to my rheumy for a few weeks yet.

[Knip in reply to Neonkittie17]

Shame you didn't have a blood test coming up, but no, I'm sure they wouldn't do it as a separate appointment. Hope you get enough blood when you do it again, and we look forward to knowing your result. Take care.

[Neonkittie17 in reply to Knip]

Thank you. Yes, bad timing on that one!

[Poshcards in reply to Neonkittie17]

I am of the understanding that these anti body tests are over £50 each, is this the case, because if they are free then I would love to know how to get hold of them please x

[Neonkittie17 in reply to Poshcards]

The one I sent for for is an vaccine antibodies test for the spike protein to the virus and is not a free test. Mine was £40 plus £8 postage. x. The most popular ones are the Roche quantitative “immunity tracker” tests which some labs and Lloyds chemists use. x

[Jacey15 in reply to GinnyE]

The antibody test offered by pharmacies etc only measure the ones you get from an infection, not the antibodies to the spike protein from the vaccines.

[GinnyE in reply to Jacey15]

Not what it says on Lloyd's pharmacy site

[Neonkittie17 in reply to GinnyE]

It’s the right one Ginny and Lloyds and my lab have given us the correct test to do for spike protein. I’ve seen the Lloyds site too but I chose the other lab as I saw it first. Only reason. (It’s probably the Roche you’re doing as they are the manufacturer of the main quantitative test.)

[Neonkittie17 in reply to Jacey15]

Mine is the spike protein vaccine antibodies test offered by an established private testing laboratory. It’s the main Roche quantitative one and is the correct one to have, from what is currently available for home test. (I’ve checked with a consultant and lab techs.) The Lloyds one is the same I understand in so far as it is also quantitative and tests again the spike protein. Yes, there are other tests which aren’t relevant.

[helixhelix]

The conclusion of that (very small) study says

“Limitations of the study included its small numbers and the fact that the specific levels of immunogenicity necessary for protection have not been fully established.”

So although the response for some people on Methotrexate may not be as strong, the likelihood is that for most of us it will be enough to protect you from serious disease.

My rheumy advised me to stop MTX before amd after vaccine, which I was pleased to do. And in France people who are severely immune-suppressed (much, much more than MTX) are being given three doses. I imagine something similar might be happening in the UK.

However as NeonKittie says at lots of this is speculation until results of the bigger studies are known. So carry on being careful, but try not to fret.

[Wobbies]

Frankly, I am past caring. I will be sensible wearing a mask, wash my hands, hand gel with me at all times and maintain my distance, but I think that this is as good as it gets in protection terms and so I have to take my chances. Can't maintain the hermit lifestyle any longer. As a family, we have agreed that we will not hug so that no-one feels awkward about it, and with this weather we tend to meet outside anyway. So, I cannot fret any longer. It is all too much.

[AgedCrone in reply to Wobbies]

Good plan Wobbies ....life is far too short to spend it worrying about something you have so little control over.

[Neonkittie17 in reply to Wobbies]

I’m taking steps to make myself as safe as possible re my RA med and it’s side effects and I have set the ball rolling already for a while now re changing meds so I’m not always as immune suppressed. That’s my best proactive approach which my nurse agrees is right for me to pursue. Then when I have B cells back and Ig levels are acceptable and not causing constant bronchitis/side effects, I’ll be able to do more. High spec meds do come with some restrictions but the amount of restriction is when you ask yourself if you want go keep doing it. I don’t.

[Wobbies in reply to Neonkittie17]

That sounds like a good plan. We have to get on with life making it as safe as possible for us without being over restrictive.

[Sheila_G]

Whoever is right makes no difference. It is what it is. Worrying about it isn't going to alter the facts. I always imagine that I will have no immunity and that I could be a carrier anyway and that everyone else has got it too so I keep my distance, wear a mask and wash, wash, wash. That way I know that everyone I see as well as myself are as safe as I can be.

[Neonkittie17 in reply to Sheila_G]

That’s exactly what my nurse said and exactly what is my thinking.

[Sheila_G in reply to Neonkittie17]

So glad you agree.

[Neonkittie17 in reply to Sheila_G]

I do and we must do what we feel is right Sheila and not anything that others want to try persuade us to do.

[Millie66]

In my opinion both are detrimental to health.

[ruth_p]

As Helix said it is a small study with many limitations, but even if it does turn out to be the case surely a 62% efficacy is better than 0% from not having the vaccine?

[Neonkittie17 in reply to ruth_p]

I think too the studies done so far are too small. The Octave is said to be 5000 immunosuppressed patients which is a better sized sample, and should include many more RD patients on high spec biologics, etc. Those such as transplant patients who share the same meds we do too. Hopefully by end of the year we will see how much certain meds may blunt the vaccines’ efficacy. I’d already worked it from early last year re timing/efficacy re own med (no arrogance here .. I was told to wait until 2-3 months after Rtx, ideally in autumn 2019 before I had the flu and pneumonia vaccines.)

[BoneyC]

Surely there would be lots of factors at play including dosage of MTX. One person on 20mg might not be the same as another person on 20mg etc.

[Neonkittie17 in reply to BoneyC]

Exactly .. and I’m sure the Octave will look at dosage and other factors of someone’s medical conditions.

[Sue4983]

It’s so hard to know what to do I’m having my second vaccine today and was thinking by July I might be able to start doing a few things again Now I’ve seen this study I’m not so sure My biggest question is whether to have my young grandchildren to stay We go for walks but it’s not the same as tucking them into bed at night and reading them a story ! What does everyone else do ?

[Neonkittie17 in reply to Sue4983]

Ask your rheumy/nurse’s advice as not all the biologics are as restrictive as others. They don’t all all deplete your immunity the same way. Depends on where you live too. I’m an area that tops the virus cases chart most weeks. 😑 It’s difficult as places are opening up but I that doesn’t make it safer that they are, and also the end of restrictions next month is before many people have got their first vaccine. Not everyone wants them either so you can’t reply on everyone else, but it’s gone really well so far and let’s hope we get more people vaccinated. Hope you can get some guidance to give you confidence from your rheumy team. 💗 x

[Sue4983 in reply to Neonkittie17]

Yeah thanks for that I find that it’s very difficult to explain to others even family and they just keep saying I’m being too cautious and have got to start living my life again I reply I do realise that and no one wants to to start living again more than me I just don’t think most people understand unless it’s happening to them !

[Beckymar]

Hi yes I have a similar problem as Sue 4983. I have Benepali 50 mg weekly snd 20 mg injection weekly. I was never told to miss my injections when having Oxford AstraZeneca vaccine. I am going out but being really careful to mask and distancing etc but my partner insists all is well abs I am being over the top. He hugs people and refuses to follow guide lines. We have a family gathering next week and I am dreading it. I feel I’m best not going as it will cause friction if I am stand-off ish but if I don’t go then I won’t know how close he has been interacting. It’s s difficult call.