A practical approach for vaccinations including COVID-19 in autoimmune/autoinflammatory rheumatic diseases: a non-systematic review

Abstract

The COVID-19 pandemic has occupied the world agenda since December 2019. With no effective treatment yet, vaccination seems to be the most effective method of prevention. Recently developed vaccines have been approved for emergency use only and are currently applied to large populations. Considering both the underlying pathogenic mechanisms of autoimmune/ autoinflammatory rheumatological diseases (AIIRDs) and the immunosuppressive drugs used in treatment, vaccination for COVID-19 deserves special attention in such patients. In this article, we aimed to give simple messages to the clinicians for COVID-19 vaccination in patients with AIIRDs based upon the current evidence regarding the use of other vaccines in this patient group. For this purpose, we conducted a "Pubmed search" using the following keywords: Influenza, Hepatitis B, Pneumococcal, and Shingles vaccines and the frequently used conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Likewise, an additional search was performed for the COVID-19 immunization in patients with AIIRDs and considering such drugs. In summary, patients with AIIRDs should also be vaccinated against COVID-19, preferably when disease activity is under control and when there is no concurrent infection. Low-degree immunosuppression does not appear to decrease antibody responses to vaccines. Ideally, vaccinations should be done before the initiation of any biological DMARDs. Patients receiving rituximab should be vaccinated at least 4 weeks before or 6 months after treatment. Since tofacitinib may also reduce antibody responses, especially in combination with methotrexate, it may be appropriate to discontinue this drug before vaccination and to restart after 14 days of immunization.

Safety of the ChAdOx1 nCoV-19 and the BBV152 vaccines in 724 patients with rheumatic diseases: a post-vaccination cross-sectional survey

“…The ideal time for vaccination in AIRD may be when disease activity is low, patients are on minimal immunosuppression, and before the initiation of any biological DMARD (Disease-modifying anti-rheumatic drug) especially rituximab [ 19 ]. These ideal conditions might not be possible in the wake of a gigantic second wave of COVID-19 engulfing our country.…”

Correspondence on ‘Immunogenicity and safety of anti-SARS-Cov-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort’

“…Guidelines for RTX treated patients recommend to perform vaccination at least 4 weeks prior or 6 months after infusion. 9 However, in AAV patients, a more delayed B-cell repopulation has been described compared with other immunological diseases. 10 Of note, up to more than 60 months of B-cell depletion after induction with RTX has been described in AAV patients, suggesting an intrinsic dysregulation of the B-cell compartment in this disease.…”

Rheumatology university faculty opinion on coronavirus disease-19 (COVID-19) vaccines: the vaXurvey study from Egypt

“…Ideally, vaccinations should be made before the initiation of any biological DMARDs. Timing of vaccination is especially important in the case of rituximab [44]. A task force of the Korean College of Rheumatology (KCR) formulated a set of vaccination guidance.…”