COVID-19 Vaccination and Immunosuppressive Therapy in Immune-Mediated Inflammatory Diseases

Abstract

The COVID-19 vaccination program has probably been the most complex and extensive project in history until now, which has been a challenge for all the people involved in the planning and management of this program. Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapy have required special attention, not only because of the particular haste in carrying out the process but also because of the uncertainty regarding their response to the vaccines. We now have strong scientific evidence that supports the hypothesis that immunosuppressive therapy inhibits the humoral response to vaccines against other infectious agents, such as influenza, pneumococcus and hepatitis B. This has led to the hypothesis that the same could happen with the COVID-19 vaccine. Several studies have therefore already been carried out in this area, suggesting that temporarily discontinuing the administration of methotrexate for 2 weeks post-vaccination could improve the vaccine response, and other studies with various immunosuppressive drugs are in the same line. However, the fact of withholding or interrupting immunosuppressive therapy when dealing with COVID-19 vaccination remains unclear. On this basis, our article tries to compile the information available on the effect of immunosuppressant agents on COVID-19 vaccine responses in patients with IMIDs and proposes an algorithm for the management of these patients.

Effectiveness and Safety of the COVID-19 Vaccine in Patients With Rheumatoid Arthritis in a Real-World Setting

“…Our seroconversion data in patients treated with TNF antagonists, JAK inhibitors and IL6 receptor inhibitors were also generally favorable, in accordance with those described by other authors, who did not find a relevant effect of these drugs on the humoral response, or it was only mild when used in combination, especially with MTX [21][22][23]27,31,33,38,45]. The use of ABA and RTX seemed not to be a big problem in our patients either, differing from what has been published to date since both ABA and especially RTX have been associated with a negative effect on the humoral response [21][22][23]27,31,33,38].…”

Effectiveness and Safety of the COVID-19 Vaccine in Patients with Rheumatoid Arthritis in a Real-World Setting

“…Despite the fact that we have no statistical power to analyze specific DMARDs individually, patients undergoing treatment with non-MTX csDMARDs, aTNF, JAKinh, and IL6 receptor inhibitors had adequate humoral seroconversion, unless administered in combination, especially with MTX, is in line with literature [21][22][23]27,31,33,41,48]. Our ABA and RTX data should be interpreted with caution due to the small number of patients on these therapies.…”