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GeneralRCT

Temporary Cessation of DMARD Therapy and COVID-19 Supplemental Dose Vaccine Immunogenicity in Patients With Inflammatory Arthritis

JAMA Internal Medicine · 5 Oct 2026

Rigour55/100
Clinical45/100
Impact†49/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

Patients on biologics or JAK inhibitors commonly ask whether to pause treatment around vaccination, and this trial suggests pausing adds flare risk without a measurable antibody gain.

The evidence

This multicentre randomised trial enrolled 840 adults with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis who were taking a TNF inhibitor, abatacept, an IL-17 inhibitor, or a JAK inhibitor. Patients either held the drug for 2 weeks after a COVID-19 booster or kept taking it. Antibody rise was similar in both groups (ratio of geometric mean fold rise, hold vs continue, 0.96; 95% CI 0.36 to 2.56), but holding roughly doubled self-reported flares (OR 2.27; 95% CI 1.41 to 3.65), especially with JAK inhibitors. The flares were short-lived.

Geometric mean fold rise of anti-RBD IgG from baseline to 6-week follow-up: Risk ratio 0.96 (95% CI 0.36 to 2.56; ratio). The interval includes no difference. This does not establish equivalence or rule out an important effect.

Why this rigour score?

Multicentre RCTDesign starting point: 63.4

55/ 100

Raised the score

  • Concealed allocation+5.1
  • Prospectively registered+5.1

Lowered the score

    No negative adjustments recorded.

    Score capped at 55. The conclusion asserts a benefit the primary outcome did not show.

    Methods at a glance

    Recorded assessment
    • Outcome assessors blindedNot reported
    • Allocation concealedMet
    • Random sequence generatedMet
    • Intention-to-treat analysisMet
    • Adequate statistical powerNot reported
    • Prospective registrationMet

    Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

    See the full score breakdown
    Study design starting point
    63.4
    Concealed allocation
    +5.1
    Random sequence generation
    +2.5
    Compared against current standard of care
    +3.4
    Intention-to-treat analysis
    +3.4
    0% loss to follow-up
    +1.7
    Prospectively registered
    +5.1
    Methodological cap
    −29.7
    Final rigour score rounded
    55 / 100

    Study design sets the starting point and a ceiling of 100. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

    Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

    For journal club

    1.For a patient with rheumatoid arthritis on a JAK inhibitor who is due for a COVID-19 booster, how would you counsel them about pausing versus continuing their medication?

    2.Given that abatacept, JAK inhibitors, and methotrexate were linked to weaker antibody responses, how should vaccine timing factor into choosing or starting a biologic in a patient expected to need repeated vaccinations?

    Original publication title

    Temporary Cessation of DMARD Therapy and COVID-19 Supplemental Dose Vaccine Immunogenicity in Patients With Inflammatory Arthritis

    Read original paper