Table 1

Characteristics of patients on MTX who held and continued MTX

MTX continued (n=33)MTX-hold (n=31)MTX all (n=64)P value*
Age, mean (SD)62.4 (14.2)59.6 (11.1)61.1 (12.8)0.391
Female, n (%)21 (63.6)24 (77.4)45 (70.3)0.251
BMI, mean (SD)26.4 (4.52)24.7 (3.30)25.6 (4.03)0.102
Rheumatic diagnosis0.759
 Rheumatoid arthritis, n (%)21 (63.6)23 (74.2)44 (68.8)
 Psoriatic arthritis, n (%)5 (15.2)2 (6.5)7 (10.9)
 Others, n (%)†7 (21.2)6 (19.4)13 (20.3)
Medication0.553
 MTX-mono, n (%)14 (42.4)12 (38.7)26 (40.6)
 MTX+prednisolone, n (%)7 (21.2)5 (16.1)12 (18.8)
 MTX+anti-TNF-α, n (%)‡4 (12.1)7 (22.6)11 (17.2)
 MTX+anti-TNF-α+prednisolone, n (%)‡5 (15.2)2 (6.5)7 (10.9)
 MTX+others, n (%)§3 (9.1)5 (16.1)8 (12.5)
 Additional prednisolone, n (%)12 (36.4)8 (25.8)20 (31.3)0.377
 Prednisolone dose (mg/day), mean (SD)3.0 (1.8)2.6 (1.1)2.9 (1.6)0.572
 MTX dose (mg/week), mean (SD)13.2 (4.5)13.1 (4.1)13.2 (4.3)0.973
 MTX oral application, n (%)16 (48.5)10 (32.3)26 (40.6)0.205
Vaccination0.896
 BNT162b2, n (%)24 (72.7)23 (74.2)47 (73.4)
 mRNA-1273, n (%)5 (15.2)3 (9.7)8 (12.5)
 AZD1222, n (%)3 (9.1)4 (12.9)7 (10.9)
 AZD1222+BNT162b2, n (%)1 (3.0)1 (3.2)2 (3.1)
 Vaccine interval in days, mean (SD)39.0 (14.8)41.9 (15.3)40.4 (15.0)0.444
Immune response
 Days from second vaccination, mean (SD)35 (23)28 (22)32 (22)0.237
 Anti-RBD-IgG (S/CO), mean (SD)3.7 (3.4)6.3 (2.6)5.0 (3.3) 0.001
 Neutralising capacity (%), mean (SD)61.2 (30.2)83.1 (21.2)71.8 (28.3) 0.001
 Responders, neutralisation capacity, n (%)¶25 (75.8)30 (96.8)55 (85.9) 0.017
 Responders, anti-RBD-IgG response, n (%)**21 (63.6)30 (96.8)51 (79.7) 0.002
MTX-hold
 For both vaccinations, n (%)NA24 (77.4)
 For only the first vaccination, n (%)NA2 (6.5)
 For only the second vaccination, n (%)NA5 (16.1)
 Duration of MTX-hold for first vaccination (days), mean (SD)NA15.1 (6.6)
 Duration of MTX-hold for second vaccination (days), mean (SD)NA16.9 (6.6)
  • Significant results are in bold.

  • *P values compare MTX continued and MTX-hold and were calculated using the exact unconditional z-pooled test for binary variables (female, additional prednisolone, MTX oral application, responders neutralisation capacity, responders anti-RBD-IgG response), χ² test for categorical variables (rheumatic diagnosis, medication, vaccination) and unpaired t-test with Welch’s correction for continuous variables.

  • †For MTX continued: ANCA-associated vasculitis (n=1), axial spondyloarthritis (n=1), polymyalgia rheumatica (n=2), systemic sclerosis (n=1), myositis (n=1), systemic lupus erythematosus (n=1). For MTX-hold: axial spondyloarthritis (n=1), polymyalgia rheumatica (n=1), primary Sjögren’s syndrome (n=1), systemic sclerosis (n=2), myositis (n=1).

  • ‡Adalimumab, certolizumab, etanercept, golimumab, infliximab.

  • §For MTX continued: hydroxychloroquine (n=1), secukinumab (IL-17 inhibitor, n=1), ustekinumab (IL-12/IL-23 inhibitor, n=1). For MTX-hold: hydroxychloroquine (n=1), leflunomide (n=2), leflunomide+prednisolone (n=1), secukinumab (IL-17 inhibitor, n=1).

  • ¶Defined as neutralising capacity against SARS-CoV-2 ≥30%.

  • **Defined as anti-RBD-IgG levels >1.0 S/CO.

  • ANCA, antineutrophil cytoplasmic antibody; BMI, body mass index; IL, interleukin; MTX, methotrexate; NA, not available; S/CO, signal/cut-off; TNF, tumour necrosis factor.