flu jab and methotrexate

[Amb1xkr]

hi I am having my flu jab this weekend and am taking 25mg methotrexate and Adilimumab. Do I stop either of them before or after?

Thanks

[Neonkittie17]

Hi Amb, I pause either side as I’ve had Covid vaccine non-responses in the past and don’t want to risk anything, but it’s your decision unless you’ve been told by your rheumy team to do anything specific. Otherwise, up to each of us to decide if we’ll flare if we miss a couple of Mtx. Hope you can think what’s best for you. I don’t know about your biologic … Only my own .. Abatacept, which I am told to pause one week before and two after, but that’s due to my poor vaccine responses before. Can you phone the rheumy helpline and ask for clarification on the biologic?

[Amb1xkr in reply to Neonkittie17]

Thank you for advice. It’s so conflicting between different Rheumatologists. There’s no wonder we are all confused.🫤

[Neonkittie17 in reply to Amb1xkr]

It is difficult to know what to do! With my immune being so bad due to past Rtx, they tend to be a bit more cautious with me.

[bpeal1 in reply to Amb1xkr]

It’s not necessarily different rheumatologists having different views but more likely advice is different for different patients. There is quite a lot of research that shows pausing methotrexate around vaccinations for people whose disease activity is well controlled increases the response to the vaccine. However, the important thing here is well controlled disease, if pausing methotrexate causes a flare then this will significantly reduce the effectiveness of the vaccine (even more so than the methotrexate will). Therefore if it’s thought that pausing methotrexate may cause a flare often the advice is not to pause it.

If you are unsure what to do contact your rheumatology team to get specific advice for you.

[Amb1xkr in reply to bpeal1]

Thank you. I’ll contact Rheumy.

[Dexter1414 in reply to Amb1xkr]

What did the rheumatology say to you as I’m due my covid vaccine next Saturday I had my flu vaccine didn’t pause tablets then

[hazelcats]

I'm having my first ever flu jab in a couple of weeks. I checked with the rheumy nurses if it would be ok, as I am just out of a flare that I took steroids for, and just added in hydroxy along with the MTX (Metoject). She never said to stop meds because of the flu jab, I guess due to risk of further flares if I stop the dmards?

[Neonkittie17 in reply to hazelcats]

I guess it is yes, but I prefer to be very cautious as I’ve had poor responses to flu and Covid vaccines. I’d not flare if I stopped my meds for 2-3 weeks but it could make a big difference to some. x

[bpeal1 in reply to hazelcats]

See my comment above. Hopefully this will make sense to you too.

[hazelcats in reply to bpeal1]

Thank you bpeal1, its fair to say my disease is NOT well controlled as yet. Having just finished the 6 week course of steroids due to a flare, I did feel reassured that the nurse inferred it is better for me to continue on the dmards when having the flu vaccine. But its always extra reassuring when a person who does have the condition and has personal experience can advise too. Thank you.

[Gilliancheche]

I think you should check with your rheumatology dept. I happen to have an appointment with my consultant just recently so asked her what I should do. She said have both the vaccinations as they are not live, do not pause my medications as I am just (hopefully) getting over a flare, but only have one at a time!

[RAGuy]

I have found that there is no hard and fast rule; it depends on how well you are doing, which is different for each of us.

I will try to simplify what I think is the essence of the current advice.

If your RA is well controlled, you can stop the MTX a week before. If you need the MTX because it is not well controlled, keep taking MTX

Stopping your MTX after the flu or Covid jab for one week or even two improves the vaccine's effectiveness. However, if you need the MTX, it is probably better to have your MTX.

I know. There are lots of "can" and "probably," but that seems the best I can distil at the moment from everything I have read.

I hope this helps

[Amb1xkr in reply to RAGuy]

Thank you. It seems this is definitely an individual thing I’ve missed one week and have flu jab Friday so I’ll see how I’m faring.

[RAGuy in reply to Amb1xkr]

Different but the same sounds ridiculous but that is what it seems. It is the common bits that are very helpful. I have flu + covid jab next Wednesday. Putting all my possible reactions in to one week lol

[Runrig01]

My rheumatologist says to stop MTX 2 weeks for covid vaccine, but no need to stop for flu.

[Amb1xkr in reply to Runrig01]

That’s reassuring as after missing last weeks methotrexate I’ve started flaring. I’m only having flu jab this week as I didn’t have last Covid until late June so can now stagger them. Thank you

[SingingJay in reply to Runrig01]

Do you mean stop it for two weeks afterwards?

[Runrig01 in reply to SingingJay]

Yes, so I’m having both jabs today. Normally I would have taken my MTX on Wednesday, but I omitted it this week, and will do the same next week

[SingingJay in reply to Runrig01]

Thanks Runrig01. I’m in a bit of quandary as having stopped MX for 5 wks due to radiotherapy, I was due to start again today but my flu vaccine is tomorrow and my Covid the following Saturday. Maybe I’ll start back on a low dose.🤔

[Green230461]

I was told by my rheummy team to stop a week either side of the jab to allow my body to accept the jab.

I have done this each time, they have worked very well. Good luck to you 🤞🏻

[Amb1xkr in reply to Green230461]

I think that’s my preferred option but today I have started with a flare in my elbow. So might now have to take methotrexate 😟 thanks for sharing your take on this