Pausing Arthritis Medicines for a COVID Booster Didn’t Raise Antibody Levels

CATEGORY: IMMUNE HEALTH

The two-week pause did nothing for the antibodies. In a randomized trial of 840 adults with inflammatory arthritis, holding medicines like TNF blockers and JAK inhibitors after a COVID-19 booster left antibody responses essentially identical to continuing them, while arthritis flares more than doubled, hitting 21% of those who paused versus 9% of those who didn’t.¹

A question that comes up every booster season

Millions of people take immune-suppressing drugs for rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis, a form of inflammatory spine arthritis. The same suppression that calms their joints can blunt a vaccine, so patients and rheumatologists keep facing the same choice: pause the drug and risk the disease, or keep taking it and risk a weaker shot. There was real reason to think pausing would help. An earlier UK trial found that stopping methotrexate, an older arthritis drug, for two weeks after a booster roughly doubled the antibody response, at the cost of more short-term flares.²

Hold for two weeks, or carry on as prescribed

The COVER trial put the newer drugs to that same test. Researchers across a US rheumatology practice network enrolled 840 patients due for a COVID-19 booster, each taking a TNF inhibitor, an IL-17 inhibitor, abatacept or a JAK inhibitor (a daily pill that damps immune signaling inside cells). A random draw, not the patient or the doctor, decided who held their drug for two weeks after the shot and who carried on without a break. Six weeks later, the rise in virus-fighting antibodies was measured in both groups. The ratio between them was 0.96. That’s as close to even as trial results get.

Flares doubled, then settled

What the pause did change was the arthritis. Within six weeks, 21.1% of those who held their medicine reported a meaningful flare, against 9.1% of those who continued, which is about 12 extra flares for every 100 people who paused. The effect was sharpest among people on JAK inhibitors, the drugs that wash out of the body fastest. Flares generally settled once treatment resumed, and both groups had recovered by six weeks. The authors’ conclusion was blunt for a medical journal: routinely interrupting these drugs around a booster is probably not warranted. The methotrexate result from the earlier trial still stands; this one says it doesn’t extend to the newer biologics and JAK inhibitors.

Key Takeaways

• Pausing TNF inhibitors, IL-17 inhibitors, abatacept or JAK inhibitors for two weeks after a COVID-19 booster didn’t improve antibody response in a randomized trial of 840 adults with inflammatory arthritis.
• Flares roughly doubled with the pause (21% vs 9%), were worst with JAK inhibitors, and generally settled once treatment resumed.
• The finding is the opposite of what an earlier methotrexate trial showed, so the answer appears to depend on which drug is involved.
• Antibody levels were the trial’s yardstick; it wasn’t large enough to count actual COVID-19 infections.

References

1. Curtis JR, Mudano AS, Cutter G, et al. Temporary Cessation of DMARD Therapy and COVID-19 Supplemental Dose Vaccine Immunogenicity in Patients With Inflammatory Arthritis: The COVER Randomized Clinical Trial. JAMA Internal Medicine. 2026; DOI 10.1001/jamainternmed.2026.4894. link
2. Abhishek A, Boyton RJ, Peckham N, et al. Effect of a 2-week interruption in methotrexate treatment versus continued treatment on COVID-19 booster vaccine immunogenicity in adults with inflammatory conditions (VROOM study): a randomised, open label, superiority trial. The Lancet Respiratory Medicine. 2022;10(9):840–850. link