Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept.
OBJECTIVE
To evaluate the influence of low-dose MTX and etanercept treatment on efficacy of measles, mumps and rubella (MMR) revaccination in children with juvenile idiopathic arthritis.


METHODS
A prospective nested case-control study was performed to investigate markers of MMR revaccination induced humoral and cell-mediated immunity in 15 patients with juvenile idiopathic arthritis (ages 6-17 yrs), treated with either low-dose MTX therapy alone or in combination with etanercept. The control group consisted of 22 healthy children. Production of IFN-gamma by T memory cells upon in vitro stimulation with measles, mumps and rubella antigens and seroprevalence of virus-specific IgG antibodies were assessed. Medication use, disease activity and patients' comments on side-effects were observed during the period of 6 months before and after revaccination.


RESULTS
Low-dose MTX therapy following MMR vaccination proved not to hamper T-cell mediated immunity in vitro. Neither low-dose MTX nor etanercept treatment, given simultaneously with revaccination, markedly interfered with generation of long-lived virus-restricted T cells and protective levels of virus-specific IgG antibodies. No increase in disease activity or medication use was seen within 6 months after MMR revaccination, including JIA patients using etanercept. No overt measles, mumps, rubella or secondary severe infections were noted.


CONCLUSIONS
Low-dose MTX and etanercept treatment do not seem to interfere with intended outcome of MMR revaccination in children with JIA.
Borte
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Department of Clinical Immunology and Transfusion Medicine, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany. stephan.borte@medizin.uni-leipzig.de
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D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology / Q000627:therapeutic use*; D007223:Infant; D007371:Interferon-gamma / Q000276:immunology; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008727:Methotrexate / Q000627:therapeutic use*; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome; D055815:Young Adult
D000914:Antibodies, Viral; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D022542:Measles-Mumps-Rubella Vaccine; D018124:Receptors, Tumor Necrosis Factor; D007371:Interferon-gamma; D000068800:Etanercept; D008727:Methotrexate