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Skipping biologics or JAK inhibitors around COVID-19 vaccination doesn't boost antibody responses — but it does raise the risk of disease flares. A new randomized trial in JAMA Internal Medicine found no meaningful immunogenicity difference between patients who held vs. continued their medications, while those who paused therapy were more than twice as likely to experience an inflammatory arthritis flare.
For patients with inflammatory arthritis on biologics or JAK inhibitors, pausing medication around COVID-19 vaccination has been a common — if unproven — practice. A new multicenter randomized trial published in JAMA Internal Medicine puts that habit to rest: holding therapy for 2 weeks around a supplemental COVID-19 vaccine dose offered no meaningful boost in antibody levels compared to continuing treatment as usual.
The study enrolled 840 patients with rheumatoid arthritis, psoriatic arthritis, or axial spondylarthritis on TNF inhibitors, IL-17 inhibitors, abatacept, or JAK inhibitors. Both the "hold" and "continue" groups showed substantial IgG antibody increases from baseline — with no statistically significant difference between them. But patients who paused their meds faced a significantly higher risk of disease flare, particularly those on JAK inhibitors.
Key Takeaways:
Why it matters: This trial provides the first prospective evidence that the "hold your meds" strategy — borrowed from methotrexate data — doesn't translate to other immunomodulatory therapies. Clinicians can now confidently advise patients to get vaccinated without interrupting their biologic or JAK inhibitor treatment.
