Weighing the Pros and Cons of Pausing Methotrexate for COVID shots

April 5, 2022

Methotrexate, a medication taken by many people with rheumatoid arthritis (RA), is an immunosuppressant. This means that it reduces the activity of the immune system, which could potentially hinder protective vaccine responses. The American College of Rheumatology along with many rheumatologists have advised RA patients to pause their methotrexate usage for 1-2 weeks following the receipt of their COVID-19 vaccine.

A recently published study in the Annals of the Rheumatic Diseases analyzed the pros and cons of pausing methotrexate usage. The study included 129 RA patients in Brazil who received two doses of Sinovac’s CoronaVac vaccine*. 60 of the RA patients paused their methotrexate usage for two weeks after each vaccine dose, while the remaining 69 RA patients were told to continue their regular methotrexate usage.

The group that continued their regular medication regimen demonstrated a 55% antibody response from the COVID vaccines whereas the group that paused methotrexate demonstrated an 80% antibody response. However, there was an increase in RA disease activity in 38% of those who had paused their medication regimen.


* The CoronaVac vaccine is an inactivated vaccine, not an mRNA vaccine (as are Pfizer and Moderna). For more information on the differences between the COVID-19 vaccines, check out our Vaccine Comparison Chart.