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Rheumatology Advance Access published online on December 11, 2008
Rheumatology, doi:10.1093/rheumatology/ken436
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept

S. Borte1, U. G. Liebert2, M. Borte3,4 and U. Sack1

1Department of Clinical Immunology and Transfusion Medicine, 2Department of Virology, University of Leipzig, 3Department of Paediatrics, Municipal Hospital St Georg Leipzig and 4Department of Paediatrics, University of Leipzig, Leipzig, Germany

Correspondence to: S. Borte, Department of Clinical Immunology and Transfusion Medicine, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany. E-mail: stephan.borte{at}medizin.uni-leipzig.de


  Abstract

Objectives. 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.

KEY WORDS: Measles, Mumps, Rubella, MMR vaccine, Juvenile idiopathic arthritis, Methotrexate, Etanercept, Cell-mediated immunity, Enzyme-linked immunospot assay

Submitted 20 April 2008; revised version accepted 16 October 2008.
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