RMD Open. 2022;8(1):e002110 doi: 10.1136/rmdopen-2021-002110Vaccine sub-study of the BALANCE-EXTEND upadacitinib trial finds that approximately two-thirds of patients receiving upadacitinib 15 mg once-daily achieve a satisfactory humoral response to pneumococcal 13-valent conjugate (PCV-13) vaccine, despite receiving concomitant methotrexate (MTX).It is well known that a weakened immune response, comorbidities and immunosuppressant drug therapy all contribute to an increased susceptibility to infections in patients with RA. Likewise, the morbidity and mortality associated with Streptococcus pneumoniae infection means a pneumococcal vaccination is recommended in patients with RA receiving csDMARDs or bDMARDs. To this end, Winthrop, et al. investigated the immunogenicity of PCV-13 vaccination in patients with RA receiving upadacitinib and background MTX.