Table 6.
Influence of disease-modifying antirheumatic drugs on influenza and pneumococcal vaccine efficacy and immunogenicity
| Efficacy | Immunogenicity | LoE Immunogenicity | ||
| Influenza | Pneumococcal | |||
| MTX | No data | Adequate for influenza/reduced for pneumococcal | 2a | 2b |
| Other cs-DMARD | No data | Only for HCQ Adequate |
4 | 4 |
| Anti-TNFα | No data | Adequate | 2a | 2b |
| B cell depletion | No data | Reduced | 2a | 2b |
| Belimumab | No data | Pneumococcal: preserved | – | 2b |
| Tocilizumab | No data | Preserved | 2b | 2b |
| Abatacept | No data | Controversial Probably mildly reduced |
4 | 4 |
| Tofacitinib | No data | Adequate for influenza, reduced for pneumococcal | 2b | 2b |
| Glucocorticoids (±other IS) | No data | Adequate for influenza, mildly reduced in high doses GC for pneumococcal | 4 | 2b |
cs-DMARD, conventional synthetic disease-modifying antirheumatic drugs; GC, glucocorticoids; HCQ, hydroxychloroquine;IS, immunosuppressives; LoE, level of evidence; MTX, methotrexate; TNF, tumour necrosis factor.