Table 6

Influence of disease-modifying antirheumatic drugs on influenza and pneumococcal vaccine efficacy and immunogenicity

EfficacyImmunogenicityLoE Immunogenicity
Influenza Pneumococcal
MTXNo dataAdequate for influenza/reduced for pneumococcal2a2b
Other cs-DMARDNo dataOnly for HCQ
Anti-TNFαNo dataAdequate2a2b
B cell depletionNo dataReduced2a2b
BelimumabNo dataPneumococcal: preserved2b
TocilizumabNo dataPreserved2b2b
AbataceptNo dataControversial
Probably mildly reduced
TofacitinibNo dataAdequate for influenza, reduced for pneumococcal2b2b
Glucocorticoids (±other IS)No dataAdequate for influenza, mildly reduced in high doses GC for pneumococcal42b
  • cs-DMARD, conventional synthetic disease-modifying antirheumatic drugs; GC, glucocorticoids; HCQ, hydroxychloroquine;IS, immunosuppressives; LoE, level of evidence; MTX, methotrexate; TNF, tumour necrosis factor.