Table 3.

Medication management at the time of non–live attenuated vaccine administration

	Influenza vaccination	Other non–live attenuated vaccinations
Methotrexate	Hold methotrexate for 2 weeks after vaccination*	Continue methotrexate
Rituximab	Continue rituximab†	Time vaccination for when the next rituximab dose is due, and then hold rituximab for at least 2 weeks after vaccination
Immunosuppressive medications other than methotrexate and rituximab	Continue immunosuppressive medication	Continue immunosuppressive medication

= Conditional recommendation.

^*Hold only if disease activity allows. Non-rheumatology providers, e.g., general pediatricians and internists, are encouraged to give the influenza vaccination and then consult with the patient’s rheumatology provider about holding methotrexate to avoid a missed vaccination opportunity.

^†Give influenza vaccination on schedule. Delay any subsequent rituximab dosing for at least 2 weeks after influenza vaccination if disease activity allows.