A practical approach for vaccinations including COVID-19 in autoimmune/autoinflammatory rheumatic diseases: a non-systematic review
- 22 March 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 40 (9), 1-13
- https://doi.org/10.1007/s10067-021-05700-z
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. Key points • COVID-19 vaccinations should preferably be made during remission in patients with autoimmune/autoinflammatory rheumatological diseases. • Low-degree immunosuppression may not interfere with antibody response to vaccines. • Ideally, vaccinations should be made before the initiation of any biological DMARDs. • Timing of vaccination is especially important in the case of rituximab.This publication has 94 references indexed in Scilit:
- Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritisArthritis Research & Therapy, 2014
- Treatment with the Interleukin-17A-Blocking Antibody Secukinumab Does Not Interfere with the Efficacy of Influenza and Meningococcal Vaccinations in Healthy Subjects: Results of an Open-Label, Parallel-Group, Randomized Single-Center StudyClinical and Vaccine Immunology, 2012
- Impact of tocilizumab therapy on antibody response to influenza vaccine in patients with rheumatoid arthritisAnnals Of The Rheumatic Diseases, 2012
- Treatment of autoinflammatory diseases: results from the Eurofever Registry and a literature reviewAnnals Of The Rheumatic Diseases, 2012
- The cellular immune response to influenza vaccination is preserved in rheumatoid arthritis patients treated with rituximabVaccine, 2011
- A multicentre, randomised, double-blind, placebo-controlled trial with the interleukin-1 receptor antagonist anakinra in patients with systemic-onset juvenile idiopathic arthritis (ANAJIS trial)Annals Of The Rheumatic Diseases, 2010
- Influenza and Meningococcal Vaccinations Are Effective in Healthy Subjects Treated with the Interleukin-1β-Blocking Antibody Canakinumab: Results of an Open-Label, Parallel Group, Randomized, Single-Center StudyClinical and Vaccine Immunology, 2010
- Vaccination response to protein and carbohydrate antigens in patients with rheumatoid arthritis after rituximab treatmentArthritis Research & Therapy, 2010
- Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximabArthritis & Rheumatism, 2009
- Poor serological responses upon influenza vaccination in patients with rheumatoid arthritis treated with rituximabAnnals Of The Rheumatic Diseases, 2007