Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force

Abstract

Objective To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Update to “guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force”

“…Author details 1 Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. 2 Lauro Wanderley Universitary Hospital, Federal University of Paraíba, R. Tab.…”

“…The Committee of Endemic and Infectious Diseases and the Executive Board of the Brazilian Society of Rheumatology (SBR) proposed an update to the “Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force” [ 1 ] based on recently published scientific evidence [ 2 ] and on the new recommendations of the Brazilian National Immunization Program (NIP) for vaccination of immunocompromised persons [ 3 , 4 ]. According to the NIP documents [ 3 , 4 ], the primary vaccination series is composed of three doses of Coronavac or ChAdOx-1 (AstraZeneca) or mRNA BNT162b2 (Pfizer), or two doses of Ad26.COV2.S (Janssen).…”

Immunogenicity of Vaccines Against SARS-CoV-2 In Patients With Rheumatic Diseases

“…[36] Контроль ( 43) ГК (50) и др. у больных в целом (p<0,0001) и при лечении МТ (р=0,0017) E. Simader РА (53), mРНК МТ (55), ГИБП (51), Положительный АТ-ответ после первой и соавт. [37] СпА (46), ГК (22) из таблицы, ритуксимаб (РТМ), ГК, MT, абатацепт (АБЦ), микофенолата мофетил (ММФ) и иJAK ухудшают ответ на вакцину против SARS-CoV-2 у многих пациентов.…”

“…Несмотря на ряд нерешённых проблем, связанных с иммуногенностью и безопасностью вакцинации против SARS-CoV-2, эксперты всех международных и национальных ревматологических АНТИБИОТИКИ И ХИМИОТЕРАПИЯ, 2022, 67; 5-6 научных обществ [49,[52][53][54][55][56], включая Ассоциацию ревматологов России [57], поддерживают положение о том, что польза от вакцинации значительно превосходит потенциальный вред, связанный с развитием нежелательных явлений, поскольку вакцинация, несомненно, снижает риск инфицирования SARS-CoV-2 и тяжёлого течения COVID-19. Решение о проведении вакцинации против SARS-CoV-2 должно быть индивидуализированным, с учётом текущей эпидемической ситуации, активности ИВРЗ, характера проводимой терапии, основываться на достижении взаимопонимания между врачом и пациентом и происходить при обязательном подписании пациентом информированного согласия.…”

COVID-19 vaccination in patients with rheumatic diseases — status February 2022

“…Some studies have shown a lower response in in this group of patients compared to healthy controls. It is unclear whether this is attributable to the underlying disease or its treatments [1].…”