The effect of disease-modifying antirheumatic drugs on vaccine immunogenicity in adults

Article Figures & Data

TABLE 1

Selected disease-modifying antirheumatic drugs

Antimetabolite

Methotrexate

Tumor necrosis factor inhibitors

Adalimumab

Certolizumab

Etanercept

Golimumab

Infliximab

Anti-CD80/CD86

Abatacept

Janus kinase inhibitors

Baricitinib

Tofacitinib

Upadacitinib

Anti-CD20

Rituximab

Interleukin (IL-) 6 inhibitors

Sarilumab

Siltuximab

Tocilizumab

IL-17 inhibitors

Brodalumab

Ixekizumab

Secukinumab

IL-12/23 inhibitors

Ustekinumab

TABLE 2

Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity

DMARDs	Influenza vaccine	PPSV23	PCV7/13	Live zoster vaccine	Recombinant zoster vaccine	Hepatitis B vaccine	Human papillomavirus vaccine
Methotrexate	Decrease^14,15	Decrease^14,24	Decrease²⁸	No effect^17,34	Not studied	Not studied	No effect^40,41
TNF inhibitors	No effect¹⁴	No effect^14,24	No effect^28,29	Study pending, contraindicated³⁵	Study pending	Decrease^37–39	No effect^40,41
Abatacept	No effect¹⁶	No effect¹⁶	Decrease³⁰	Study pending, contraindicated	Study pending	Not studied	Not studied
Janus kinase inhibitors	No effect¹⁷	Decrease¹⁷	No effect^31,32	Not studied, contraindicated	Study pending	Not studied	Not studied
Rituximab	Decrease^14,18,19	Decrease^19,25	Decrease^30,33	Not studied, contraindicated	No effect³⁶	Not studied	Not studied
IL-6 inhibitors	No effect²⁰	No effect²⁰	No effect³⁰	Not studied, contraindicated	Not studied	Not studied	Not studied
IL-17 inhibitors	No effect^21–23	No effect²⁶	Not studied	Not studied, contraindicated	Not studied	Not studied	Not studied
IL-12/23 inhibitors	Not studied	No effect²⁷	Not studied	Not studied, contraindicated	Not studied	Decrease³⁸	Not studied

DMARDs = disease-modifying antirheumatic drugs; IL = interleukin; PCV7/13 = 7- or 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine; TNF = tumor necrosis factor