Flu vaccination and Methotrexate

[AmberGamble]

Just a quickie soliciting your reliable advice.

My docs have been pestering me to have the Covid vaccination which is a firm no from me for my own reasons, and also the Flu vaccination which I’ve always had with no issues. I have booked the flu one for next week.

Now I’m on MTX, I’m sure I’ve read that it’s advisable to miss the following 2 doses of MTX after the shot. I would rather not miss any and the professionals both at my GP practice and also at the Rheumatology centre obviously state it’s perfectly fine and to still take the MTX.

Have I dreamt what I think I read?🥺

[DorsetLady PMRGCAuk volunteer]

No you haven't dreamt it,many rheumies do suggest you don't take MTX for 2 weeks after vaccine.

This is conclusion from one study on RA patients and flu vaccine -

Conclusions

In conclusion, a temporary discontinuation of MTX for 2 weeks after vaccination improves the immunogenicity of a seasonal influenza vaccine in patients with RA on stable dose of MTX without appreciably increasing disease activity.

Most studies re Covid vaccines agree ...

But as we say, your decision based on your circumstances and medical advice

[PMRpro Ambassador]

You have not dreamt it - it is the conclusion after studies on the matter.

[PMRrunner]

I was advised not to take methotrexate for two weeks after flu or covid vaccinations. If it helps I've never really noticed missing the dose

[AmberGamble in reply to PMRrunner]

My additional concern is that I’ve just started to taper down from 10mg today so I’m rather anxious to have to miss 2 weeks of MTX.

[PMRrunner]

It's your decision of course but I've always felt that if the current taper takes a couple of weeks longer than originally planned then that's what it is.

[Hidcote]

I wish there was some consistent guidance about this. I had read the advice to pause methotrexate for two weeks after flu and Covid jabs to gain maximum benefit but my local Rhematology nurses said that as I had relapsing PMR I should continue and my GP also said the local guidelines were to continue. It may be different if one is onMTX for RA. I did continue the MTX but worry that the vaccinations will be less effective. It would be helpful if the guidelines were clear. The Rhematology nurses said that after 3 months the benefits of pausing or continuing were the same but I suspect that is because the benefits decline over 3 months so the difference evens out.

[PMRpro Ambassador in reply to Hidcote]

The rheumatologists are more concerned with RA than for PMR. The effect of MTX persists for some weeks so it is unusual for it to be a problem in PMR. After all, MTX has no proven record in PMR and you would/should stop it if you have an infection. No different.

[Hidcote in reply to PMRpro]

Yes, I had to stop the MTX because I went on antibiotics because of an adverse reaction to the RSV jab. I have little faith in the MTX but feel I have to give it a go before giving it up.

[PMRpro Ambassador in reply to Hidcote]

That's what I say - it does work for a few, who knows why, but you have to try it before saying no.

[OakOwl]

I'm on methotrexate (MTX) and pred as well.

I read it's best to not to take MTX 10 to 14 days after vaccinations, but can take it just before. So since I take it every 7 days, got my covid and flu shots 1 1/2 days after MTX dose, and then skipped just one dose, and delayed my next MTX dose by one day from my usual day of the week (so a 13 1/2 day gap if I've done my math right).

No affect on my PMR that I could tell. Am hoping the vaccines worked and that I interpreted the timing correctly!

So just illustrating that you may only need to miss one dose, not two (I think). I can look up my source later if you'd like.

[AmberGamble in reply to OakOwl]

Thank you, that’s an angle I hadn’t considered😊 I’ll see if I can change my flu vaccination to the day after my MTX and adjust accordingly.

I’ve not missed my flu jab for years and didn’t want to miss it this winter!

[KASHMIRI1]

I take Meth and pred and my rheumy said not to stop the meth when I had vaccinations as it was more important to keep things under control.

[PMRpro Ambassador in reply to KASHMIRI1]

Dunno - not sure what would happen if the flu/Covid jab didn't develop a good response and then you got one or the other. Because then you would have to stop the MTX anyway.