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For patients with inflammatory arthritis, holding certain disease-modifying antirheumatic drugs (DMARDs), namely select biologic or Janus kinase inhibitor (JAKi) therapies, for two weeks at the time of a supplemental COVID-19 vaccine dose does not enhance humoral immunogenicity, according to a study published online Oct. 5 in JAMA Internal Medicine.

Jeffrey R. Curtis, M.D., M.P.H., of the University of Alabama at Birmingham and colleagues randomly assigned 840 patients with inflammatory arthritis to continue or hold therapy for two weeks following administration of their next supplemental COVID-19 vaccine dose. The patients had received a primary mRNA COVID-19 vaccine series and were receiving anti-tumor necrosis factor medications, anti-interleukin-17 inhibitors, abatacept or JAKi.

The researchers found that from baseline to the postdose visit, there were substantial increases in severe acute respiratory syndrome coronavirus 2 spike immunoglobulin G antibody levels across all groups. The geometric mean fold rise ratio (hold/continue) was 0.96 (95% confidence interval, 0.36 to 2.56) in the primary intention-to-treat analysis, indicating no significant between-arm difference in humoral immunogenicity. Across drug subgroups and drug half-life categories, the results were consistent.

Disease flare risk was significantly increased with holding therapy (odds ratio, 2.27; 95% confidence interval, 1.41 to 3.65), which was most pronounced among those who used JAKi therapies. Comparable adverse events were seen between medication arms and occurred more frequently in the hold group.

"Given the increased flare risk and absence of humoral immunogenicity benefit, these findings do not support routine temporary interruption for COVID-19 vaccine optimization," the authors write.

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