COVID-19 Vaccination in Patients with Autoimmune Inflammatory Rheumatic Diseases: Clinical Guidance of the Korean College of Rheumatology

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused more than 100 million infections and 2 million deaths worldwide. In up to 20% of cases, COVID-19 infection can take a severe, life-threatening course. Therefore, preventive measures such as mask-wearing, hand hygiene, and social distancing are important. COVID-19 vaccines that use novel vaccine technology can prevent up to 95% of infections. However, the uncertainty regarding the efficacy and safety of vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), who are immunocompromised due to underlying immune dysfunction and concomitant immunosuppressive treatment, warrants clear guidance. A task force of the Korean College of Rheumatology formulated a set of vaccination guidance based on the currently available data and expert consensus. The currently available COVID-19 vaccines are considered to be safe and effective. Every patient with AIIRD should receive one of the available COVID-19 vaccines unless contraindicated for medical reasons such as prior allergy/anaphylaxis to the COVID-19 vaccine or its components. Patients should continue immunosuppressive treatment for their underlying AIIRD, including biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Corticosteroids should be reduced to the lowest dose possible without aggravating the AIIRD. To improve the vaccine response, methotrexate can be withheld for 1–2 weeks after each vaccination, and the timing of rituximab and abatacept infusion should be adjusted if clinically acceptable. Rheumatologists should play a leading role in educating and vaccinating patients with AIIRD.

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

“…These are pertinent questions, and both patients and rheumatologists around the world are anxious for answers [ 21 ]. The current consensus does not prefer any one vaccine over any other [ 22 ]. Our study has provided the initial information regarding safety and we plan to follow it up with data on immune response, especially after the completion of two doses of the vaccines as per recommended schedules.…”

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

“…Corticosteroids should be reduced to the lowest dose possible without aggravating the AIIRD. To improve the vaccine response, MTX can be withheld for 1-2 weeks after each vaccination [45].…”

Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia

“…В целом отсутствие синтеза нейтрализующих антител имело место у каждого 10-го пациента (9,5%), o n l i n e fi r s t Таблица 3. Рекомендации по терапии и вакцинации пациентов с ревматическими заболеваниями в период пандемии COVID-19 [90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] Продолжение таблицы 3 o n l i n e fi r s t страдающего ИВРЗ, и у каждого 100-го (0,5%) в группе контроля. Наконец совсем недавно было показано, что базовое лечение МТ ассоциируется с неадекватным синтезом анти-SARS-CoV-2 (у 62,2% пациентов) и отсутствием вирусспецифической активации CD8 + -Т-клеток [169].…”