Influenza vaccination and interruption of methotrexate in adult patients in the COVID-19 era: an ongoing dilemma.
Influenza vaccination and interruption of methotrexate in adult patients in the COVID-19 era: an ongoing dilemma.
复制标题
DOI：
10.1016/s2665-9913(20)30392-1
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Isaacs JD
中科院分区：
文献类型：
--
作者：
Mehta P;Sanchez E;Moraitis E;Longley N;Lendrem DW;Giles IP;Chambers RC;Ciurtin C;Isaacs JD
随着COVID-19疫情持续不减及流感季节来临，公共卫生当局强调接种流感疫苗至关重要。1接种疫苗可减轻流感感染的严重程度，并预防流感，1这可能有助于保护已经紧张的卫生保健资源。欧洲抗风湿联盟建议，对于大多数慢性自身免疫性炎症性风湿病患者，应强烈考虑每年接种流感疫苗，因为这些患者由于固有或医源性免疫损害而感染的风险增加。2.对于自身免疫性炎症性风湿病患者，目前尚无最佳的流感灭活疫苗配方（效价或剂量）。这些患者可能需要终身免疫抑制，有时可能需要短期中断免疫调节以恢复免疫应答（例如，严重感染或大手术）。有趣的是，一些临床医生暂时停止甲氨蝶呤（例如，免疫前或免疫后一周）在类风湿关节炎患者中，以优化流感疫苗接种的疗效，尽管这种方法不受指南的支持。在本评论中，我们考虑了在COVID-19大流行期间这一策略的证据基础和影响。
With the COVID-19 pandemic continuing unabated and the advent of the influenza season, public health authorities have emphasised that influenza vaccina tion is of paramount importance. 1 Vaccination can reduce the severity of influenza infection and prevent hos pi tal isa tions, 1 which might help to conserve already strained health-care resources. The European League Against Rheumatism recommends that annual influ enza vaccination should be strongly considered for most patients with chronic autoimmune inflamma tory rheu matic diseases, as these patients are at increased risk of infection due to inherent or iatrogenic immuno com promise. 2 There is no optimal formulation (valency or dose) of inactivated influenza vaccine for patients with autoimmune inflammatory rheumatic diseases. These patients require potentially lifelong immunos uppression, and short-term interruption of immunomodulation might sometimes be necessary to restore immune responses (eg, with severe infection or major surgery). Anecdotally, some clinicians temporarily discontinue methotrexate (eg, one week before or after immunisation) in patients with rheumatoid arthritis to optimise the efficacy of influ enza vaccination, although this approach is not supported by guidelines. In this Comment, we consider the evidence base for and implications of this strategy during the COVID-19 pandemic.