Table 1

Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity

InfluenzaPneumococcalHerpes zosterHepatitis BHuman papilloma virusTetanusSARS-CoV-2 (mRNA)
Methotrexate14 22 24 50 51 OK (ZVL)52 OK117 132 133 121 82 84 85
TNF inhibitorsOK14 16 20 27 28 OK14 56 OK (ZVL)64 103–105 OK117 132 OK121 124*OK84 85 88
Rituximab↓↓14–17 19–21 24 134 ↓↓14 18 45–47 18 121 ↓↓81–84
Abatacept24 26 45 46 OK (SQ)122
↓(IV)123
84
JAK inhibitorOK30 30 OK (tofacitinib)120
↓(baricitinib)53
82 84
IL-6R inhibitorOK31 OK31 OK125 OK84
IL-12/IL-23 inhibitorOK32 OK54 105 OK54 OK82
IL-17 inhibitorOK33–35 OK55 OK55 OK84
  • OK indicates no significant/meaningful effect on vaccine immunogenicity (may include reduction in absolute postvaccination titres if rates of protective titres are unchanged.) ↓ reduces vaccine immunogenicity. ↓↓ significantly reduces vaccine immunogenicity. For OK, ↓ and ↓↓ if no control group is available, data are compared with expected vaccine responses in the general population. Empty cells indicate lack of data.

  • IL, interleukin; JAK, Janus kinase; RZV, recombinant zoster vaccine; SQ, subcutaneous; TNF, tumour necrosis factor; ZVL, zoster vaccine live.